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					MONDAY, SEPTEMBER 4                                                                                                                                        1

INVITED PRESENTATIONS                                                         FM1.01.03
                                                                              THE DOPPLER ULTRASOUND ON THE FETAL VENOUS
EN1.01.01                                                                     SYSTEM IN THE ESTIMATION OF THE FETAL WELL BEING –
COMPLICATIONS OF LAPAROSCOPY                                                  POSSIBILITIES AND LIMITS
C. Chapron, J.B. Dubuisson, Service Chirurgie Gynécologique, CHU              F. Stamatian, D. Diculesu, Tunde Kovacs – Dept. OB/GYN, University
Cochin, Paris, France.                                                        of Medicine and Pharmacy «I. Hajteganu» Cluj-Napoca, Romania

Introduction: For a number of gynaecological indications the results of       The introduction of Doppler sonography in perinatology has enabled the
laparoscopic treatment are comparable with those of laparotomy. Like          non-invasive assessment of cardiovascular hemodinamies in human
all surgery, operative laparoscopy does bring with it a risk of               fetuses. Over the last 15 years, data on healthy as well as on
complications which need to be assessed. This work has three goals: to        compromised human fetuses has been collected, and Doppler has proved
assess the risk of laparoscopic surgery in gynaecology; to specify the        to be more sensitive that other methods in predicting adverse perinatal
modalities for the diagnosis and treatment of complications; to               outcome.
determine the part played by the surgeon’s degree of experience.              The findings of absent end – diastolic flow in the ombilical artery is
Materials and methods: A multicentric study was carried out in seven          acknowledged as a sign of increased placental vascular resistance with
French centres for laparoscopic gynaecological surgery. This series runs      increased risk of retardation, imminent fetalk asphyxia during labor and
over a period of 9 years and covers 29,966 diagnostic and operative           high perinatal mortality.
laparoscopic operations.                                                      Severe decrease of the umbilical blood flow is usually associated with
Results: The mortality rate is 3.33 per hundred thousand laparoscopies.       redistribution of vascular flows, centralization of circulation, a
The overall cnd (96 cases). The complication rate is significantly            phenomenon which aims at maintaining adequate nutrition and
correlated with the complexity of the laparoscopic procedure                  oxygenation of vital organs.
(p = 0.0001). One out of three complications (34.1%; 43 cases) occurred       At the same time with hemodinamic alterations, cardiac output is also
while setting up for laparoscopy, and one out of four complications           redistributed. Several Doppler studies showd that in fœtus who have no
(28.6%) were not diagnosed during the operation. As new indications for       telediastolic flow in the umbilical artery the left ventricle becomes
laparoscopic surgery in gynaecology have appeared, there has been a           dominant, while other studies reported the right one as dominant. In our
parallel and statistically significant increase in the rate of urological     study we investigated prospectively the central (inferior vena cava;
complications (p = 0.001). Increased experience by the surgeons has had       ductus venosus, cerebral transverse sinus, cerebral inferior sagittal sinus,
three consequences: a statistically significant drop in the number of         median cerebral artery) and peripheral (umbilical artery, umbilical vein)
bowel injuries (p= 0.0003), a drop in the rate of complications requiring     hemodinamic changes in foetuses presenting zero or reverse telediastolic
laparotomy for those laparoscopic surgical procedures which are well-         flow in the umbilical artery. The study was carried out from the time of
defined (p = 0.01) and a change in the way complications are treated,         diagnosis of birth. Hemodynamic alterations were correlated with fetal
with a significant increase in the proportion of incidents treated by         heart recordings and the condition of the new born at delivery.
laparoscopy (p = 0.0001). Complication rate is 4.64 per thousand              Our study, although carried out in a small number of patiens (12 cases),
laparoscopies (139 cases). The rate of complications requiring                seems to emphasize that alterations on the venous canal are very similar
laparotomy is 3.20 per thousand laparoscopies (139 cases).                    with the alterations on the cerebral venous circulation, and these
Conclusions: The risk of complications is related to the complexity of        modifications occur too late to initiate any really effective therapy.
the laparoscopic procedure.The set-up phase for laparoscopy must never
be considered banal. The part played by the surgeon’s experience
highlights the importance of the methods and training assessment in           FM1.02.01
these new techniques                                                          ETHICS OF PRENATAL DIAGNOSIS
                                                                              F. A. Chervenak (1), L. B. McCullough (2), (1) Dept. OB/GYN, Cornell
                                                                              University, New York, NY, United States, (2) Center for Medical Ethics,
FM1.01.02                                                                     Baylor College of Medicine, Houston, TX, United States
A. Kurjak, Dept OB/GYN, «Sv.Duh» Hospital, Zagreb, Croatia                    Objective: To identify the ethical implications of respect for autonomy
                                                                              for routine ultrasound.
Objectives: The aim of the study was to explain the role and diagnostic       Study Methods: Ethical analysis utilizing the ethical principles of
possibilites of three dimensional ultrasonography in detection of fetal       beneficence, respect for autonomy, justice, and the ethical virtues of
abnormalities.                                                                prudence and professional integrity.
Material and Methods: The cases were collected during the two year            Conclusions: Providing patients with information about diagnostic and
period of three dimensional scanning in low risk and high risk                therapeutic alternatives is an essential component of respect for the
population of pregnant women.                                                 patient’s autonomy. Failure to provide the patient access to information
Results: The amount of information and the ability to detect more             deprives the patient of the opportunity to consider alternatives about the
anomalies earlier is continually mounting using a three dimensional           management of her pregnancy, some of which may be highly in accord
scanning. Main advantages of three dimensional sonography in prenatal         with the patient’s values. Nondisclosure of diagnostic alternatives
diagnosis is a better visual evaluation of image planes that cannot be        therefore seriously impairs the exercise of the patient’s autonomy.
obtained with conventional 2D due to anatomic constraints and fetal           Routinely offering obstetric ultrasound respects the autonomy of
position. Particularly, this new technology does include improved             pregnant women and not routinely offering obstetric ultrasound
assessment of complex anatomic structures, surface scan analysis of           systematically disrespects the autonomy of pregnant women, beause the
fetal face, volumetric measurements of organs, spatial presentation of        woman’s access to the diagnosis of serious anomalies and, therefore,
blood flow and three dimensional examination of fetal extremities and         access to abortion for serious fetal anomalies is restricted.
Conclusion: Owing to the 3D volume scanning, detailed examination of
fetal anatomy is possible and a lot of minor and maior deformities are        FM1.02.02
much easier to recognize. Particular benefit is related to the detection of   FETAL SURGERY: CLINICAL AND ETHICAL ISSUES
minor deformities which do represent markers of chromosomal                   Mark I. Evans, Hutzel Hospital, Wayne State University, Detroit, USA
abnormalites, and 3D technology is usefull for increasing the selectivity
of ultrasonic diagnosis.                                                      Throughout the last 15 years, there has been a concerted effort at a small
                                                                              number of centers worlwide to attempt to ameliorate the sequelae of
                                                                              genetic and congenital diaphragmatic hernia, sacrococcygeal teratoma,
                                                                              congenital cystic adenomatoid malformations of the lung, and more
                                                                              recently, meningomylocele. Percutaneous approaches have included the
                                                                              shunting of obstructive uropathies, pleural effusions, and previously,
                                                                              obstructive hydrocephalus. Mtabolic interventions have been successful
                                                                              for congenital adrenal hyperplasia, methylmalonic aciduria, biotin
                                                                              deficiency, and Smith-Lemli-Optiz syndrome. Pharmacologic agents
2                                                                                                                                                                      MONDAY, SEPTEMBER 4

have reversed fetal cardiac arrhythmias. Preconceptual folic acid has         cancer. There are few comparative studies to resolve this questions. The
reduced the recurrence risk of neural tube defects, and mass scale            WHO study iniciated in 1979 until 1988 is one of the main study
supplementation of breads and grains is likely to reduce the incidence of     involving 8 developing and 3 developed countries, using a common
primary neural tube defects. Genetic therapies have recently focused on       protocol of case–control study.
stem cell transplantation, which has been unequivocally successful in x-      Table 1: Relative risk of gyneacological cancer in women who ever use
linked SCIDS (severe combined immunodeficiency disorder), and has             oral contraceptives
been tried, so far without success, in other conditions. The ethical issues   Relative risk by type of Cancer (95% Confidentes Limits)
surrounding fetal therapy weigh balancing the risks of therapy to the         Countries       Breast(1)          Cervical (SQCell)   Cervical          Endometrial     Ovarian             Ovarian (8)

risks of the mother, and ensuring that these therapies are presented to                                          Invasive (2)        In Situ (3,4)     (5-6)           (7)                 Hight dosis       Low dosis

patients in an appropriate manner, without coercion towards either            Developed       1.155 cases        84 cases            ------            0.8 (   147 cases           146 cases
accepting of such therapies, or by allowing patients to have reproductive     Australia       0.94 (0.55,1.60)   0.93 (0.40, 2.15)   -------           4 cases         1.59 (0.52, 4.87)   0.80(0.07,5.04        3.47(0.26,31.32)
choices.                                                                      GDR             1.17(0.87,1.57)    ---------           ---------         ----------      ---------           ---------             ----------

                                                                              Israel          1.05(0.87, 1.27)   2.17(1.29,3.65)     ---------         37 cases        0.58(0.35,0.95)     0.53(0.25,1.04)       1.17(0.28,3.37)

ON1.01.01                                                                     Developing      961 cases          2.361 cases         1.365 cases       0.5(0.2,1.2)    515 cases           246 cases

RISK OF OVARIAN CANCER AFTER SUPRAPHYSIOLOGICAL                               Chile           1.03(0.64,1.65)    1.21(0.77,1.90      1.58(1.09,2.29)   16 cases        0.28(0.09,0.83)     0.62(0.11,2.29)       0.44(0.05,1.98)

STIMULATION                                                                   China           1.28(0.71,2.32)    -------             --------          8”              0.88(0.17,4.67)     Non use               1.50(0.13,9.43)

D. L. Healy, Monash Medical Centre, Clayton, Australia                        Colombia        1.11(0.42,2.93)    0.56(0.15,2.07)     ------            1               -----               -------               -------

                                                                              Kenya           1.11(0.50,2.50)    0.99(0.63,1.56)     --------          1               ------              -------               -------
We recently reported the incidence of invasive cancer of the ovary and        México          1.24(0.76,2.02)    1.17(0.86,1.59)     1.72(1.21,2.44)   4               1.08(0.30,3.91)     1.37(0.13,7.41)       0(0.2.69)
in a large cohort of In Vitro Fertilisation (IVF) patients to examine         Philippines     1.30(0.89,1.90)    1.34(0.87,2.07)     --------          14              0.56(0.12,2.70)     0 (0.3,50)            1.18(0.12,6.02)
whether the cause of infertility or exposure to fertility drugs was
                                                                              Chiang Mai      1.70(1.16,2.48)    1.62(1.35,1.95)     1.23(0.88,1.72)   19              0.36(0.16,0.85)     0.75(0.22,2.06        0.47(0.17,1.12)
associated with an increased cancer risk. Ten Australian IVF clinics
                                                                              Chulalongkorn   0.87(0.58,1.31)    1.34(1.08,1.65)     1.58(1.23,2.03)   14              1.20(0.57,2.52)     0.41(0.08,1.40)       0.81(0.26,2.14)
provided data for women who had been referred for IVF prior to January
                                                                              Siriraj         1.30(0.91,1.84)    1.14(0.94,1.37)     1.72(1.40,2.11)   22              0.35(0.16,0.78)     0.36(0.07,1.18)       0.38(0.07,1.25)
1, 1994. The incidence of invasive ovarian cancer was determined by
record linkage to population based cancer registries and the national         TOTAL D-D       1.15(1.02,1.29)    1.31(1.19,1.45)     1.62(1.43,1.93)   0.5(0.3,0.7)    0.59(0.44,0.78)     0.54(0.35,0.82)       0.65)0.41,1.00)
death index. The observed number of cancers was compared with the             1. The WHO Collaborative Study of Neoplasia and Steroid
expected nuber calculated by applying age – standardised general              Contraceptives. Br.J.Cancer(1990) 61, 110-119
population cancer rates to the cohort. The cohort included 29,700             2. The WHO Collaborative Study of Neoplasia and Steroid
women who were referred for IVF. 20,656 women were exposed to                 Contraceptives. Int J. Cancer (1993) 55, 228-236
fertility drugs and IVF while 9,044 were unexposed. There were 13             3. Zhan Ye David Thomas, Roberta Ray and The WHO Collaborative
ovarian cancers in this cohort. The incidence of ovarian cancer were no       Study of Neoplasia and Steroid Contraceptives. Int J. Epidemiology
greater than expected. Women with unexplained infertility had                 1995, 24, 19-26
significantly more cancers of the ovary than expected. No association         4. Molina R. Thomas D. Dabancens A., et al Oral contraceptives and
was seen between cancer incidence and the number of IVF treatment             cervical carcinoma in situ in Chile.Cancer res.1988;48:10011-1115
cycles nor with the types of fertility drugs.                                 5. The WHO Collaborative Study of Neoplasia and Steroid
                                                                              Contraceptives. Int J. Epidemiology, 1988 17, 263-269
                                                                              6. Karin A Rosenblatt, David Thomas and The WHO Collaborative
ON1.01.02                                                                     Study of Neoplasia and Steroid Contraceptives. Int J. Cancer 1991, 49,
HORMONAL AND GYNECOLOGICAL MALIGNANCY RISK                                    870-874
Charles B. Hammond, Duke University, Durham, North Carolina, USA              7. The WHO Collaborative Study of Neoplasia and Steroid
                                                                              Contraceptives. Int J. Epidemiology 1989 18, 538-545
Concern continues regarding the impact of hormonal replacement                8. Karin A Rosenblatt, David Thomas, Elizabeth A. Noonan and The
therapy for hypoestrogenic postmenopausal women on the likelihood of          WHO Collaborative Study of Neoplasia and Steroid Contraceptives.
the development of endometrial and/or breast malignancy. From                 IEurJ. Cancer 1992, 28 A , 1872-1876
available data it appears that unopposed estrogen therapy in a patient        Conclusions:
with a uterus in situ increases the risk of endometrial adenocarcinoma by     1. No difference of Relative Risk (RR) of Breast Cancer is appreciated
four- to eight-fold. However, the appropriate addition of progestogen         in developing and developed countries.
dramatically reduces that risk. Interestingly, patients who develop           2. In 2 developing countries and Israel there is a RR over 1 of Invasive
endometrial cancer while taking estrogen have a better prognosis than         Cervical Cancer not including the unit in de CL. Also in 3 developing
patients who are not taking estrogen and develop this lesion. The case of     countries there is a RR of cervical Cancer In situ over 1.
the relationship in breast cancer is less clear. A number of articles         3. There is a protective effect of endometrial cancer in both groups of
purport a modest increase in the risk of breast cancer in patients who        countries. Also in Israel, Chang Mai and Siriraj, there is a significative
take hormonal replacement, a risk that only seems to develop after a          protective effect of ovarian cancer. When the dosis of estrogens is lower,
significant interval of treatment. Recent data have suggested that the        the protective effect tend to diminish
addition of progestogen might add to the increase with either hormone.        4.It is important to go deep in studies of cerviacal cancer in developing
However, there are many refuting studies that do not show a similar           countries, mainly to elucidate the importance of HPV, STDs. and sexual
increase. Data differ somewhat between Europe and the United States           factors.
with a stronger relationship seen in the European publications. Whether
this might relate to the type and dosage of estrogen or other factors is
unknown. In general, the consensus seems that if estrogen increases the       ON1.02.03
risk of breast cancer it must be a modest increase. The author will           TO TREAT OR NOT TO TREAT HPV AND CYTOLOGY FINDINGS
present data to review these relationships in detail.                         B. G. Lindeque, University of Pretoria, Pretoria, South Africa

                                                                              Infection with human papilloma virus (HPV) is seen as a causal factor
ON1.01.03                                                                     for the development of cervical, vaginal and vulvar neoplasia. Many
ORAL HORMONAL CONTRACEPTIVES AND GYNECOLOGICAL                                more people than those developing CIN, VAIN, VIN or carcinomas of
CANCER RISK IN DEVELOPING COUNTRIES                                           the lower genital tract will however harbour HPV in their cells. Such
Ramiro Molina and David Thomas, Universidad de Chile, Santiago,               HPV may be detected by several tests in asymptomatic patients. The
Chile                                                                         question exists whether asymptomatic carriers of HPV should be treated,
                                                                              and if so, how.
The factors associated with ovary, endometrial, and breast cancer differ      Several options exist for management of asymptomatic patients,
from developed and developing countries. The prevalence of other              including HPV testing, cytological follow up, local destructive therapy
causal agents of the cervix uterus cancer as HPV, is expected to be           for visible lesion. The development of HPV testing technology opened
higher in developing than developed countries. Regarding these finding        up possibilities for risk assessment. Patients then thought to be in a high
is expected to have different epidemiological profile of gineacology
MONDAY, SEPTEMBER 4                                                                                                                                     3

risk category should be referred for colposcopy and biopsy. Current           ON1.03.02
reports state that the sensitivity of HPV testing is acceptable but           ROLE OF SURGERY WITH CURATIVE INTENT
specificity is low in detecting premalignant lesions. It appears that HPV     D. Dargent, Hôpital Edouard Herriot, Lyon, France
testing currently has limited contribution towards treatment decisions
and strategies. Cytological follow up may be less costly and maintain         It is staging tool laparoscopic surgery entered the filed of gynecologic
high sensitivity for detection of development of HSIL lesions. Patients       oncology. It has to remain at this place. Using the laparoscopic
with cytology indicative of more than HPV infection should be referred        instruments on increases the tumor manipulations and the chances for
for colposcopy, biopsy and appropriate treatment. In many countries           tumor cells seading. The insufflation creates through a “chemney effect”
patients with cytology indicating HPV only will be allocated to cytology      a risk of abdominal wall grafts. The modification to CO2 induces on the
follow up protocols, and treatment only instituted when a LSIL or             milieu enhances the growth of the tumor desposites either pre-existant or
especially a HSIL is detected.                                                created by the surgery itself. For these reasons it is only in the field of
Local destructive therapy for HPV lesions have been widely reported as        cervical cancer Stage IB1 and endometrial cancer Stages IA and IB, ie in
effective with low recurrence rates. LLETZ is used in many institutions       two situations where no direct manipulation can happen, the laparoscope
as first choice treatment.                                                    can be used in order to remove the tumor or, much better, to prepare the
Patients infected with the human immunodeficiency virus frequently            removal of the tumor which is performed through the vaginal route.
have extensive infection with HPV. Even in the absence of HSIL lesions        1/ Laparoscopic vaginal hysterectomy for Endometrial Cancer (EC)
therapy is indicated, usually medical with 5-fluoro-uracil.                   Laparoscopic is appropriate for carrying out the intraperitoneal and
HPV infection in children may alert the practitioner to the possibility of    retroperitoneal stagings which are part of the management of EC. At the
childhood sexual abuse, and will also require treatment.                      condition the cancer does not reach the subserous layer of the uterine
                                                                              wall, the uterus is not too big and the vagina is not too narrow, the TH +
                                                                              BSO can be performed with thelaparoscope while avoiding using an
ON1.03.01                                                                     intra-uterine manipulator.
THE ROLE OF LAPAROSCOPY IN THE STAGING OF                                     2/ Laparoscopic Vaginal Radical Hysterectomy
GYNECOLOGIC CANCER                                                            In cervical cancer Stage Ib1 and EC Stages II as well the laparoscopic
Denis Querleu, Eric Leblanc, Division of Gynecologic Oncology,                approach can be considered both as a staging tool and as the preparation
University of Lille, France                                                   to vaginal radical hysterectomy which is made easier and safest by the
                                                                              prior laparoscopic so called lateral paracervical lymphadenectomy. One
The end of the 80's and the early eighties were the date for "new             has better using not an intra-uterine manipulator and moving as soon as
developments" in oncologic surgery. It is now time to examine the             possible to the vaginal step of the surgery which starts with the making
outcome of patients who underwent new operations and the results of           and closing of the so called vaginal cuff and, therefore, preventing the
randomized studies.                                                           tumor cells contamination of the operative field. The conservative
The follow up of the series of patients submitted to laparoscopic             variant of this operation is named “Laparoscopic Vaginal Radical
lymphadenectomy in 1988 and 1989 and published in 1991 (Amer J                Trachelectomy”. It allows some young patients to preserve their fertility.
Obstet Gynecol 164:579) is now available. A group of the same size            3/ The future: laparoscopic assessment of the Sentinel Node (SN)
matched for age, stage, and pathology and comparable for tumor size           followed by vaginal surgery.
and node status was used as a historical control group. The five-year         The first data concerning the SN assessment in uterine cancer are
survival rates and survival curves were not significantly different           encouraging. The rate of failure is low (about 10%) the node is in nine
between the two groups. In addition, a series of node positive patients       out to ten cases located in a place where it can be easily and quickly
submitted to radiotherapy shows that the rate of radiation therapy            discovered using the laparoscope. The predictive value of its assessment
complications is reduced after laparoscopic lymphadenectomy.                  is likely to be very high. The future of laparoscopic surgery in uterine
A collaborative series from Lille and Lyon (Daniel Dargent) of more           cancer could be assessing only the SN and the move to vaginal
than 100 hundred patients presenting with less than 2 centimeters             operation.
cervical cancers features excellent results, with a recurrence rate below
2%. The conclusion is that the combination of laparoscopic staging and
vaginal surgery is appropriate for the management of early cervical           RM1.01.01
cancers.                                                                      PROGESTOGEN AND EMERGENCY CONTRACEPTION
Two randomised experimental studies on paraaortic lymphadenectomies           Pak Chung Ho, Department of Obstetrics and Gynaecology
have been carried out on pigs in our laboratory at the University of Lille.   University of Hong Kong, Hong Kong SAR, China
The first experiment showed that laparoscopic surgery gives a node
yield similar to laparotomy, with an increased operating time but a           The standard method of emergency contraception is the Yuzpe regimen.
reduced adhesion formation rate. The second one showed that a                 While about 74% pregnancies can be prevented with the Yuzpe regimen,
retroperitoneal endoscopic approach is even more efficient that               the incidence of nausea and vomiting is high. As the side effects may be
laparoscopy, providing a similar node yield and almost no de novo             related to the oestrogen component, levonorgestrel was investigated for
intraperitoneal adhesion. For this reason, we now stage the advanced          its efficacy and side effects in emergency contraception. Two
cervical cancer patients using this minimally invasive technique.             prospective randomised comparative studies from Hong Kong and
Laparoscopic lymphadenectomy, when lymph node dissection is                   World Health Organization (WHO) showed that the incidence of side
indicated is also part of the surgical management of endometrial cancer       effects of levonorgestrel was significantly lower than that of the Yuzpe
when vaginal or laparoscopic hysterectomy may be safely performed,            regimen. The WHO study also demonstrated that the efficacy of
which excludes the cases with deep myometrial invasion.                       levonorgestrel was significantly higher than that of the Yuzpe regimen.
Reassessment of inadequately staged ovarian cancer is safely and              Combining the data from the two studies, the pregnancy rate was 1.6%.
accurately performed using laparoscopic techniques, with a minimum of         The incidence of nausea was 21.1% while that of vomiting was 4.8%.
complications and reassuring long term follow-up in our series.               The pregnancy rate increased significantly with increase in the
                                                                              intercourse-treatment interval: 0.9%, 1.8% and 2.7% for intercourse-
                                                                              treatment intervals of < 24 hr, 25-48 hr and 49-72 hr respectively.
                                                                              Therefore, barriers for early administration of levonorgestrel for
                                                                              emergency contraception must be removed to obtain optimal results. The
                                                                              mechanism of action of levonorgestrel in preventing pregnancy in
                                                                              emergency contraception is still not clear. Levonorgestrel is now
                                                                              available in a number of countries for emergency contraception. If it is
                                                                              available, it should be the drug of choice. However, in many countries,
                                                                              the Yuzpe regimen remains the only available method. Repeated use of
                                                                              levonorgestrel for postcoital contraception is associated with a high
                                                                              incidence of irregular menstrual bleeding. Women with regular
                                                                              intercourse should be advised to use a regular effective method of
                                                                              contraception instead of using emergency contraception alone for
4                                                                                                                        MONDAY, SEPTEMBER 4

RM1.01.02                                                                    to 120 hours after unprotected intercourse. The results of this trial will
EMERGENCY CONTRACEPTION: MIFEPRISTONE STUDIES                                be reviewed during this presentation.
A. Glasier, Universty of Edinburgh, Edinburgh, Scotland

Emergency contraception can prevent pregnancy if used after                  UR1.01.01
intercourse has already taken place.. The antiprogesterone Mifepristone      CLASSIFICATION OF FEMALE URINARY INCONTINENCE AND
has a variety of contraceptive effects depending on the dose and the time    PROLAPSE
in the cycle when it is administered. Given as a daily low dose it will      Ulf Ulmsten, Uppsala University Hospital, S-751 85 Uppsala, Sweden
inhibit ovulation, given within 48 hours of the LH surge it has been
shown to inhibit implantation. Two studies published in 1992 reported        Female Urinary Incontinence can be diagnosed by the patient's
the results of a randomized trial comparing the effectiveness of 600 mg      subjective symptoms and the gynecologists visualising urinary leakage
Mifepristone with the standard Yuzpe regimen of emergency                    in specific situations like urgency and stress. The anamnesis and the
contraception. Taken together these two studies showed 100 per cent          physical examination are then two important tools for both subjective
efficacy of the Mifepristone regimen in a total of 600 women. There was      and objective evaluation of the disorder.
much lower incidence of all side effects when compared with the Yuzpe        Additional diagnostic tools are various types of urodynamic
regimen but Mifepristoe was much more likely to delay the onset of next      investigations and pad-tests.
menses.                                                                      For a long time uro-dynamics have been considered as a sine qua non to
Encouraged by these results, the World Health Organization (WHO)             diagnose urinary incontinence. In recent years the value of urodynamics
undertook a dose finding study of 600 mg, 60 mg and 10 mg of                 has however been questioned.
Mifepristone. There was no difference in efficacy of the three doses, all    To further penetrate the aetiology of female urinary incontinence and to
of which prevented 85% of expected pregnancies. The low incidence of         implement new therapeutic modalities one has look to tentative
side effects was confirmed and there was a dose dependent effect on the      anatomical dysfunctions in the lower urinary tract. In particular this is
timing of next menses with the lowest dose causing least delay. It is        valid for patients suffering from stress incontinence. The most important
clear from earlier research that the mechanism of Mifepristone given in      structures are the vaginal walls, the pubourethral ligaments, the pelvic
this maner depends on the timing of its administration. A randomised         floor muscles and the connective tissue connecting these structures.
comparison between Mifepristone and Levonorgestrel has recently been         Defects in these structures can induce symptoms of both stress and urge
completed by WHO. It is likely that Mifepristone will be the most            incontinence since they are all closely related to the urethral closure
effective oral method of emergency contraception that is available.          mechanisms. Based on anatomical dysfunctions new diagnostic and
However, its widespread use will be limited by its known capacity to act     therapeutic principles have been suggested.
as an abortifacient.                                                         Diagnosis of prolapse has also been intensely discussed during recent
                                                                             years and several concepts have been suggested. There is presently no
                                                                             consensus on a simple and clinical useful form to be used in order to
RM1.01.03                                                                    evaluate prolapse before and after treatment. Presently available forms,
WORLD HEALTH ORGANIZATION RANDOMIZED STUDIES ON                              which from scientific points of view are acceptable, have not reached
DIFFERENT REGIMENS OF EMERGENCY CONTRACEPTION                                world wide acceptance among the majority of clinicians working in this
Helena von Hertzen, UNDP/UNFPA/WHO/World Bank Special                        area.
Programme on Research, Development and Research Training in Human            For both prolapse and incontinence we have to consider that
Reproduction, World Health Organization, Geneva, Switzerland                 classifications endorsed by FIGO must be easy to understand and to be
                                                                             used by all gynecologists world wide. Diagnostic concepts that may
The regimen of combined oral contraceptives (COC) – 0.1 mg                   involve too sophisticated techniques may then not be prioritised in a
ethinylestradiol plus 0.5 mg levonorgestrel, repeated after 12 hours - was   primary FIGO classification.
until recently the only hormonal method for emergency contraception.
Mainly due to its side effects this method is not fully satisfactory, and
the UNDP/UNFPA/WHO/World Bank Special Programme on Research,                 UR1.01.02
Development and Research Training in Human Reproduction started,             EVALUATION OF PELVIC FLOOR DYSFUNCTION
therefore, looking for new approaches and investigated the potential of      J.M. van Geelen. Dept. Ob./Gyn. Hospital Bernhoven, Oss, The
two compounds, levonorgestrel and mifepristone, for emergency                Netherlands
The Programme organised a large randomised, double-blind,                    Pelvic floor dysfunction may give rise to genital prolapse and/or
multinational study comparing the efficacy and side effects of               functional disturbances: micturition disorders, defecation troubles,
levonorgestrel, given as two 0.75 mg doses 12 hours apart, with those of     sexual problems.
the COC-regimen. This trial produced several findings of public health       Genital prolapse: In 1996 a validated standardization document for the
importance: (i) the levonorgestrel regimen was better tolerated; (ii) the    description and evaluation of pelvic organ prolapse was adopted by
efficacy of the levonorgestrel regimen was greater, in terms of both         several professional societies: ICS, AUGS, SGS. It uses the hymen as a
crude pregnancy rates (1.1% vs 3.2%) and pregnancies prevented (89%          fixed point of reference. Six measurements (two points on the anterior,
vs 67%); and (iii) for both methods combined, efficacy was significantly     two on the posterior vaginal wall and two on the vaginal apex), the
and inversely related to time since unprotected coitus. Since publication    genital hiatus, the perineal body and the total vaginal length are used for
of these results in August 1998 a two-pill pack of 0.75 mg                   pelvic organ support quantitation.(Bump et al.1996) For the description
levonorgestrel has been registered for emergency contraception in over       of populations and for research comparisons an ordinal staging system is
fifteen countries.                                                           suggested. Five stages (0-IV) are assigned depending on the severity and
In another multinational study the Programme compared the efficacy           extent of prolapse. For a stage to be assigned to an individual woman, it
and side effects of three doses (600 mg, 50 mg and 10 mg) of the             is essential that the quantitative description be completed first.
antiprogestogen mifepristone when administered up to 120 hours (5            Functional disturbances: Observation of the perineum and digital
days) of unprotected coitus for emergency contraception. Pregnancy           examination of the pelvic floor muscles still remain the main
risks did not differ between the three treatment groups (1.3%, 1.1% and      instruments to assess the ability of the pelvic muscles to contract and to
1.2%, respectively) and the occurrence of side effects was similar except    relax selectively and to estimate the force of contraction. Ancillary
the onset of next menses, which was significantly related to mifepristone    techniques may be used: Q-tip testing, bladder neck elevation test, EMG,
dose.                                                                        pressure recordings (urethral, vaginal and rectal) and imaging techniques
An important question that remained to be answered was whether               (ultrasound, contrast radiography, CT and MRI). These techniques still
mifepristone is a better choice than levonorgestrel. To this end the         lack standardisation, validation and/or availability. For all these
Programme carried out a large multinational randomised double-blind          measurements the conditions of the examination must be specified, i.e.
study comparing the efficacy and side effects of 10 mg of mifepristone       straining, traction, position of the subject.
and two treatments of levonorgestrel, i.e. two doses of 0.75 mg of           Ref: Bump et al: Am. J. Obstet. Gynecol 175: 10,1996
levonorgestrel administered at 12-hour interval, and when the compound
was given in one single dose of 1.5 mg, in emergency contraception up
MONDAY, SEPTEMBER 4                                                                                                                                         5

UR1.01.03                                                                      varias líneas terapéuticas, pero fundamentalmente: expansores del
EVALUATION OF PELVIC FLOOR DYSFUNCTION: REPAIR                                 plasma, antitrombóticos, y corticoides.
USING A SUBVESICAL SLING                                                       Desde las observaciones del grupo de Martin, corroboradas
D.Ostergard, Dept.OB/GYN, Long Beach Memorial Hospital, Long                   posteriormente por otros investigadores, se sabe que el síndrome HELLP
Beach, CA, USA.                                                                puede beneficiarse del tratamiento con corticoides. Los corticoides
                                                                               pueden producir una mejoría transitoria del cuadro, que permite el
A cystocele may arise from a central defect or a paravaginal defect, or a      traslado de la gestante a un centro adecuado, acelerar la madurez fetal y
combination. Differentiation must be made in order to correctly treat the      producir una mejoría del estado materno en el momento del parto. En un
patient.                                                                       estudio realizado en nuestro servicio en 30 pacientes con síndrome
Many recurrences of the anterior vaginal wall prolapse are because the         HELLP, existe una tendencia a recuperarse de forma más rápida la cifra
paravaginal defect was not repaired and only a central traditional type of     de plaquetas y a la estabilidad clínica, aunque no se observa mejoría en
cystocele repair was performed. If this is done, it will enlarge the           la recuperación de AST y LDH.
bilateral paravaginal defects and create a greater potential for recurrent     Según un estudio realizado por Sibai y cols., las gestantes afectas de
cystocele as this paravaginal defect further enlarges with time.               síndrome HELLP parcial, no tenían el mismo alto porcentaje de
In vaginal paravaginal repair, the retropubic space is entered and the         complicaciones y, por tanto, este grupo debería beneficiarse aún
white line located. Sutures are placed through the white line, through the     posiblemente más de una conducta terapéutica conservadora. Por el
vaginal wall, and through the paravesical connective tissue and when           contrario, se requieren futuros estudios uqe permitan una valoración
these sutures are tied, the paravaginal defect is obliterated.                 definitiva de la conducta expectante en el síndrome HELLP completo en
Unfortunately, this technique has not led to the best results and,             caso de que la edad gestacional lo justifique.
therefore, we are now employing a trapezoidally shaped piece of cadaver
fascia which measures approximately 5 cm in its superior dimension and
9 cm in its inferior dimension, and 5 cm along each side. The traditional      SS1.02.01
nonabsorbable, permanent sutures are placed and this piece of cadaver          RECENT LEGAL DEVELOPMENT ON HIV/AIDS IN COLOMBIA
fascia is included in those sutures, however, it is not necessary then to      María Isabel Plata, PROFAMILIA, Bogota, COLOMBIA
include the medial sutures on the perivesical fascia. As of this writing,
we have performed this procedure on 50 patients and have so far                Colombia as a nation has developed during the last decade an interesting
experienced a 10% recurrence rate with the longest follow-up, now >24          package of norms protecting the fundamental rights of the HIV/AIDS
months. We are encouraged by this new approach to the repair of                patients. Rights to non-discrimination, the right to health and social
anterior compartment defects. We have noted, however, that in those            security, right to employment, right to education and right to privacy
patients where a rectocele repair has not been performed because it was        have resulted from a combination of laws and juridprudence.
asymptomatic at the first surgery, that these rectocele defects may            But what is most interesting is that the synergy generated by the tutelas
enlarge and become symptomatic. We are, therefore, at this point,              (which allow any person to seek immediate judicial protection of their
performing a posterior vaginal repair, even though the patient is              fundamental constitutional rights), the jurisprudence and the laws, has
asymptomatic.                                                                  allowed the country to move from theory to practice. The Ministry of
                                                                               Public Health has just published, last March, the Integral HealthCare
                                                                               Guidelines which include a complete and innovative human rights
SS1.01.01                                                                      approach for the care of HIV/AIDS patients. These guidelines comply
EPIDEMIOLOGIC FACTORS OF HYPERTENSIVE DISORDERS OF                             with the international human rights treaties and pay due attention to the
PREGNANCY                                                                      rights of the person. Information, informed consent, the right to privacy
José M. Belizán, Agustín Conde-Agudelo. Latin American Center for              and autonomy of the patient are now in the forefront.
Perinatology, PAHO/WHO, Montevideo, Uruguay.

Several risk factors are associated with the development of pre-               SS1.02.02
eclampsia such as nulliparity, multiple pregnancy, history of chronic          RECOGNIZING ADOLESCENTS’ EVOLVING CAPACITIES TO
hypertension, gestational diabetes mellitus, maternal age above 35 years,      EXERCIZE CHOICE IN REPRODUCTIVE HEALTH CARE
fetal malformation and overweight women. The magnitude of the risk of          R.J. Cook, Faculty of Law and Faculty of Medicine, University of
these variables is similar in populations of countries with different          Toronto, 84 Queen’s Park, Toronto, Ontario, Canada, M5S 2C5.
socioeconomic levels. Differences among countries are sought as an
attempt to identify preventive measures for the development of pre-            All countries (except Somalia and the USA) have adopted the UN
eclampsia and should be considered in research and implementation              Convention on the Rights of the Child, which usually applies to
approaches. In the case of calcium supplementation to prevent pre-             individuals aged under 18 years. The Convention requires governments
eclampsia no effect of such supplementation was seen in populations            to “respect the responsibilities, rights and duties of parents [or others
with an adequate basal calcium intake (equal or above 900 mg per day):         acting as parents] … in a manner consistent with the evolving capacities
3 studies in 4566 women showed a typical relative risk of 0.91 (95%            of the child.” Many adolescents gain capacity to make decisions for
confidence intervals 0.73 to 1.14). Whereas in populations with basal          themselves concerning reproductive and sexual health services, and to
calcium intake below 900 mg per day, calcium supplementation showed            decide issues of confidentiality. Immature adolescents must be given
a beneficial effect: 6 studies in 1842 women showed a typical relative         usual protections. The Convention sets a legal limit on parental power to
risk of 0.32 (0.22 to 0.47). This is an important issue to be considered       deny capable adolescents reproductive and sexual health services. The
and efforts to confirm these findings are necessary, since the estimated       question whether an adolescent is a “mature minor” must be decided by
of mean calcium intake in the world is around 472 mg per day and in            health service providers independently of parental judgment. The
developing countries this is around 346 mg per day.                            specific duties of government and health service providers to implement
                                                                               adolescent rights regarding their reproductive and sexual health needs
                                                                               are examined.
V. Cararach, G. Casals, S. Martínez, O. Coll, J. Figueras. ICGON-              SS1.02.03
IDIBAPS, Hospital Clínic- Universitat de Barcelona                             LEGAL CHALLENGES IN ASSISTED REPRODUCTION
                                                                               B.M. Dickens, Faculty of Law, University of Toronto, Toronto, Ontario,
La morbimortalidad maternofetal relacionada con el síndrome HELLP              Canada
ha hecho que se tienda con razón a finalizar precozmente la gestación,
con la previa estabilización de la gestante y, si es posible, el tratamiento   Challenges to be addressed include:
corticoideo para maduración fetal, antes de la semana 34. No obstante,         1. Embryo Creation. It is illegal for practitioners under contracts
en pacientes clínicamente asintomáticas con los diferentes parámetros de       requiring ethical practice to create human embryos for research,
control maternofetal estables, puede valorarse adoptar una conducta            characterized by the goal to develop generalizable knowledge. Genetic
expectante. Para aumentar la latencia diagnóstico-parto se han propuesto       research may soon require embryos created with targetted genetic
                                                                               characteristics. Where the primary goal is to treat patients’ reproductive
6                                                                                                                        MONDAY, SEPTEMBER 4

incapacity, embryos may curently be created with their gametes.               disorders) 35% of patients. Type 2: Psychosocial factors lead to
Diagnosis and therapy may generate anecdotal data of wider interest, but      psychoendocrine and psychovegetative dysfunctions which can be
creation of specific embryos for diagnosis and therapy remains lawful.        measured and quantified (functional, conversion disorders) 40% of
2. Disposal of Surplus Gametes and Embryos. A couple leaving an               patients. Type 3: Psychosocial factors lead to basic vulnerability of the
assisted reproduction program may agree that remaining gametes and            personality resulting in chronic pathological changes (psychological
embryos be available for others or research, or be destroyed. Where they      factors affecting medical conditions and psychosomatoses) 25% of
disagree, competing claims arise for control. Courts have to resolve the      patients. Integration of these models into everyday's gynecological
status of embryos, and whether they are property.                             practice will be demonstrated.
3. Multiple Implantation and Pregnancy. Codes of practice limit
embryos created in vitro that may be placed in vivo in a single cycle, but
ovarian hyperstimulation for natural insemination may produce high            SS1.03.02
multipregnancy. This endangers pregnancy, birth of healthy children,          PSYCHOENDOCRINOLOGICAL DISORDERS IN GYNECOLOGY
and maternal welfare. Advanced technologies allow selective reduction         Fabio Facchinetti, Dept. of Gynecol. Obstet. Pediat Sciences, Unit of
but, where accommodated by local abortion law, may nevertheless be            Psychobiology of Reproduction. University of Modena & Reggio
unacceptable to practitioners or patients.                                    Emilia, via del Pozzo 71, 41100 Modena, Italy
4. Gestational (Surrogate) Motherhood. When women surrender children
born from their own or other’s ova, interests in genetic, gestational and     Gynecological disorders are often an expression of psychological
social/psychological motherhood diverge. Pre-conception legal                 discomfort and distress impairing daily activities, worsening self-esteem,
agreements reduce risks of confusion and clarify birth registration, but      reducing social interactions, etc. Gynecologists should face clinical
where gestational mothers receive payments and so-called “commercial”         problems bearing in mind the above reported interactions with psychic
surrogacy is unlawful, lawyers may be professionally compromised in           world. This become particularly true for disorders linked to reproductive
negotiating agreements.                                                       function, that is menstrual and fertility problems. However, the operative
                                                                              relationships between emotions and clinical problems changes in their
                                                                              pathway according to the specific clinical condition, as outlined in the
SS1.02.04                                                                     following examples.
EMERGING ISSUES IN WOMEN’S REPRODUCTIVE RIGHTS                                Psychological distress, either acute or chronic, is the main reason
Anika Rahman, JD, Director, International Program, Center for                 accounting for the occurrence of secondary amenorrhea, even in the
Reproductive Law and Policy, New York, NY 10005                               absence of psychiatric disturbances such as eating disorders or major
                                                                              depressive disorder. Te interaction between stress and menstrual
In the more than five years since the 1994 International Conference on        function has found his roots in the pathological activation of the
Population and Development and the 1995 Fourth World Conference on            endogenous opioid system which blunted the pulsatile release of
Women, there have been significant efforts to promote women’s                 hypothalamic LH-RH, thus inducing a reversible state of hypogonadism.
reproductive health and rights worldwide. While most governments have         Often, resumption of menstrual function occur spontaneously once
yet to translate their international commitments into domestic laws and       subjects adapted to the stress stimulus or the stimulus disappear. In some
policies, there are some instances of model government action in a            other cases, a pharmacological approach requires a concomitant
variety of arenas. Moreover, non-governmental organizations (NGOs)            psychological support.
around the world have been working on a host of women’s reproductive          A more complex, two-way interaction has been established between
rights matters. Sometimes, such work has occurred in the face of              psychological distress and infertility. According to social context, couple
considerable political opposition. The question thus arises that, given the   infertility could be per se a distressing condition, therefore infertility
recent prominence of reproductive rights at the international level, what     influences psychological well-being. On the opposite, psychological
has occurred in this field. The presentation will provide an overall          discomfort reduces fertility, directly acting on the production of
background on key issues in reproductive rights globally, some trends in      gametes, in both partners of the couple. A third level of the vicious cycle
law and policy, the role of women’s NGOs and some future issues to            of stress and infertility is represented by the medically proposed
consider. Particular attention will be paid to an emerging human rights       solutions, i.e. assisted procreation. A significant proportion of couples
based approach to reproductive health.                                        were further distressed by invasive technology of baby tubes, limiting
                                                                              the success in term of pregnancy rate. Also in such cases, the activation
                                                                              of neuroendocrine circuits such as hypothalamus-pituitary-adrenal axis
SS1.03.01                                                                     and portal pituitary dopaminergic system account for hormonal
SOMATIZATION DISORDERS IN OBSTETRICS AND                                      secretions negatively affecting gametogenesis and implantation.
GYNECOLOGY                                                                    The cyclical recurrence of severe and transiently disabling physical,
J. Bitzer, University Clinic/Women's Hospital, Basel, Switzerland             psychological and behavioural symptoms in the late luteal phase of 5-
                                                                              10% of women in their 30ies is a complex, still unknown phenomenon
Introduction: Somatoform disorders in Obstetrics and Gynecology are           certainly due to an “hypersensitivity to ovarian cycle”. The steroid-brain
frequent symptoms. There is however yet no classification system which        interaction is the target of our efforts in order to understand such
is especially developped for these disorders. They can be grouped             disorder since the suppression of ovarian activity is a definite therapeutic
according to their symptomatology like obstetrical symptoms (hypereme-        approach. At present, however, several neuroendocrine relationships
sis, pain disorders during pregnancy, premature contractions, some forms      have been explored without success for a comprehensive premenstrual
of hypertensive diseases, etc.), or gynecologic symptoms (chronic pelvic      syndrome explanation.
pain without obvious pathology, pruritus, discharge without pathology,
etc.) or reproductive endocrinology (PMS, menstrual disturbances,
unexplained infertility, etc.). Another approach to classification is ICD-    SS1.03.04
10 or DSM-4, where the symptoms can be grouped into major psychiatric         MANAGEMENT OF SOMATIZATION DISORDERS IN THE
diseases or somatoform disorders which are then subdivided into               GYNECOLOGICAL CONSULTATION
somatization disorders, hypochondriasis, somatoform pain disorders, etc.      C. Maggioni & S. Mimoun, (1) University of Milan, Milan Italy, (2)
Finally, the etiologic pathogenetic approach is based on either psychody-     Hôpital Debre, Paris, France
namic models (conflict, structure-deficit models) or cognitive behavioural
models (learning theory, SORC).                                               Although much research has been conducted regarding the psycological
Methods: 65 patients presenting with somatoform disorders were                causes of disease, there is a lack of focus on women's viewpoints
examined using the above described instruments. For each patient              regarding their bodies as they relate to illness. This study examines the
gynecologic symptoms, descriptive classification (ICD 10) and model of        interpretation of body self-perception and body image by women who
symptom formation were combinded looking for patterns which would             present gynaecological complaints. Medicine allows and sustains the
help to integrate the different levels of observation to guide clinical       representation of the body like an object open to scientific investigation.
intervention.                                                                 Medicine reinforces the idea that the body is an object we can open and
Results: Through this analysis we found three types of somatoform             manipulate at will. Lastly, it reinforces the idea that only the physical
disorders. Type 1: Psychosocial factors lead to cognitive and behavioural     body is involved in the recovery process. Thus, a vicious circle is
changes which result in somatic symptoms (cognitive-processing                created, where women ask for physiologically-based reasons for illness,
MONDAY, SEPTEMBER 4                                                                                                                                      7

and gynaecologists search for physiologically-based reasons for disease,     pedonculated subserous or submucous fibroïds are a contraindication to
offering physical remedies and treatments. In turn, this reinforces the      embolization.
idea that the body is entirely and solely responsible. From the              The results of published series confirm that embolization is an effective
psychosomatic viewpoint, only a global approach including attention to       treatment for symptomatic uterine myomata.
patient's memories, psychological structures, body attitudes, words and
expressions and social relationships can offer a therapeutic approach.
Only when patients assume a subject position in the recovery process         EN1.02.03
and move from the objectified position to a leading questionning role it's   ULTRASONICALLY ACTIVATE SCALPEL FOR MYOMECTOMY
possible for them to find new solutions. Results of our study conducted      Roger Ferland, Laurie Telfer-Whelan, Barrington, RI, USA
on 100 outpatient women, by semi-structured interviews and body-
schema testing, suggest that any illness is accompanied by a                 The ultrasonically activated scalpel is a surgical energy source capable
modification of the body-schema, perception of the external world and        of incising tissue with minimal lateral thermal injury while achieving
perception of the distances existing between the self and the others.        hemostasis of capillaries and small blood vessels. By delivering
                                                                             mechanical energy generated in a piezo-electric generator, the UAS
                                                                             causes three tissue effects: 1. Disruption of hydrogen bonds in tissue
SS1.03.05                                                                    proteins 2. Cavitation of intracellular water 3. Secondary thermal effects.
PAIN SYNDROMES IN GYNECOLOGY: VULVODYNIA                                     The disruption of chemical bonds at the molecular level produces a
Ph.Weijenborg, Dept Psychosom Gyn & Sexuology                                proteinaceous coagulum that effectively seals blood vessels. This effect
Leiden University Medical Center, Leiden, The Netherlands.                   is variable depending on the size of the vessel, energy setting applied,
                                                                             and length of activation. Vessels up to 3 mm in diameter can be reliably
By the International Society for the Study of Vulvar Disease (1)             managed with the UAS.
vulvodynia is defined as chronic vulvar discomfort, characterized by the     Cavitation of intracellular water created by an area of low atmospheric
patient’s complaint of a burning and sometimes stinging sensation in the     pressure adjacent to the vibrating blade causes intracellular water to
vulvar area. Five subsets of vulvodynia have been identified (2), all of     change from the liquid phase to vapor phase at body temperature.
which result in chronic vulvar pain: vulvar dermatosis, cyclic               (Boyle's Law). This facilitates incision of tissue by causing cell
candidiasis, vulvar vestibulitis, squamous papillomatosis and essential      membranes to rupture.
vulvodynia. Proper diagnosis is a prerequisite for adequate patient          With increasing time of activation, some of the mechanical energy is
management.                                                                  transformed to thermal energy. This produces some hemostatic effect
Recently, attention has been directed to the essential or dysesthetic        similar to resistance thermal units, but at much lower operating
vulvodynia (3-5). Research (5) has supported the idea that essential         temperatures (80 deg. C) and with much less lateral thermal injury (1mm
vulvodynia represents a unique syndrome, rather than a subset of vulvar      vs. 3-7 mm).
vestibilitis. The etiology is unknown. Some reports suggest a relation       Effective transfer of mechanical energy is dependant on coupling of
with cysts of the sacral nerve roots (6). An association with                blade motion with the target tissue. Thin filmy tissue such as peritoneum
psychological distress is found (4). Optimal management should include       can be incised only if adequate tension is created between the blade and
multispecialistic medical care as well as attention to the consequences of   tissue. Otherwise the tissue will not absorb energy and there will be no
the pain syndrome on the psychological and sexual life of the patient.       tissue effect.
1. BurningVulvar Syndrome: Report of the ISSVD. J Reprod Med                 In the case of myomectomy, the solid firm tissue of myometrium and
1984;29:457.                                                                 fibroid readily absorbs mechanical energy. This maximizes tissue effect
2. McKay M. Subsets of vulvodynia. J Reprod Med 1988;33:695-8.               and allows to rapid cutting without generation of excessive heat.
3. McKay M. Dysesthetic (“essential”) vulvodynia: treatment with             Additionally, since the energy transfer is not dependant on electrical
amitriptyline. J Reprod Med 1993;38:9-13.                                    current, blood does not reduce the power density as it may with use of
4. Stewart DE, Reicher AE, Gerulath AH, Boydell KM. Vulvodynia and           monopolar electrosurgical units.
psychological distress. Obstet Gynecol 1994;84:587-90                        Although I have no second look data in the human, experimental porcine
5. Bornstein J, Zarfati D, Goldshmid N, Stolar Z, Lahat N, Abramovici        models demonstrate fewer adhesions to uterine horn transection sites
H. Vestibulodynia-a subset of vulvar vestibulitis or a novel syndrome?       performed with UAS vs. electrosurgery. This presumably results from
Am J Obstet Gynecol 1997;177:1439-43.                                        less thermal injury and ischemia at incision sites with better preservation
6. Van de Kleft E, Van Vyve M. Chronic perineal pain related to sacral       of TPA activity to prevent adhesions.
meningeal cysts. Neurosurgery 1991;29:223-6.                                 For these reasons, the UAS seems a superior energy modality for

ARTERIAL EMBOLIZATION OF UTERINE FIBROIDS                                    FM1.03.01
J. H. Ravina, A. Aymard, N. Ciraru-Vigneron, O. Ledreff, J. Clerissi,        IMPLANTATION AND MOLECULAR BIOLOGY
D. Herbreteau, J. J. Merland, Clinique Spontini, Paris, France               S. K. Smith, D. Rocha, A. Sharkey, Department of Obstetrics and
                                                                             Gynaecology, University of Cambridge, The Rosie Hospital, Cambridge,
Since uterine artery embolization (UAE) for fibroïds disease was first       United Kingdom
reported (1995) his procedure is being increasingly adopted at the end of
1999 more 6000 embolizations are realised in the world.                      Implantation remains the principal cause of failure in patients seeking to
The technique consists of selectively catheterising both uterine arteries    achieve a healthy pregnancy. New evidence suggests that the oocyte and
under free flow conditions. UAE is performed with polyvinyl alcohol          embryo are an important feature in this failure but it is still thought that
particles until interruption of arterial blood flow.                         interactions between the embryo and endometrium are the principal
Population: All patients before embolization were symptomatic and            factors involved in the failure of implantation. The development of a
justified surgical treatment in every case the average age was 42/43 and     cyclical endometrium under the influence of steroids essentially involves
80% were older than 40.                                                      the coordinated response of a variety of cells to promote the
Results: All the large series have the same results six months after UAE,    development of receptive endometrium. The process of implantation
92 to 94% of patients are symptomatic free.                                  begins with attachment of the embryo to the epithelium surface and the
Hemorrhage are stopped in more 90% and cycle became normal quickly.          subsequent apoptosis of epithelial cells and the interstitial migration of
Average reduction in fibroïd volume was 60/65% at 6 months and 70 to         trophoblast into the endometrial surface. Individual genes have yet to be
75% at one year. The shrinkage is so more large in very young women.         identified in humans that are differently regulated to induce their
At this time any relapse was observed.                                       implantation. However, genetic manipulation in mice has begun to
The recurrent complication is the frost embolization pain and required       identify a range of molecules whose ablation or over-expression results
powerfull analgesy (intraveinous narcotics PCA).                             in abnormal implantation. The first of these was the LIF gene and that
Major complications are rare the most serious were infection with one        has been followed by evidence of abnormalities of the interleukin-11
fatal case, few cases of ovarian failure and transient amenerrhea were       receptor, a gene that shares with the LIF ligand signal accessory
observed, but normal pregnancies can result after UAE. Large                 transduction molecule GP130. Further evidence suggests that LIFgene
                                                                             expression is regulated by hox genes and deletion of these genes also
8                                                                                                                          MONDAY, SEPTEMBER 4

results in failed implantation and abnormalities of hox gene expression         compared to gestationally-matched normal placentae. Increasing oxygen
have been identified in endometrium of patients with endometriosis, a           tension up-regulates PlGF protein in term placental villous explants,
condition assumed to be associated with failed implantation. Differential       whereas hypoxia down-regulates. Angiopoietin-2 is decreased in IUGR
gene display and micro array analysis of gene expression at the time of         placenta thus possibly allowing early maturation of placental
implantation are likely to lead to gene maps that define the overall gene       vasculature. The addition of PlGF to a first trimester cytotrophoblast cell
expression of receptive endometrium. As with malignancy the narrow              stimulated cell proliferation. In contrast, the addition of PlGF had little
focus of gene expression in individual cell types is unlikely to provide        on effect endothelial cell proliferation. These changes provide a
the necessary genetic and proteomic explanation for failed implantation.        molecular explanation for the observed poor angiogenesis in the
Studies involving analysis of cognate gene sets are likely to lead to           pathogenesis of IUGR and thus demonstrate the importance of these
greater understanding of the integrated circuicitry necessary for the           growth factors in the establishment of normal pregnancy.
coordinated regulation of mammalian implantation.

FM1.03.02                                                                       IMMUNOLOGY ASPECTS OF IMPLANTATION
TROPHOBLAST INVASION                                                            Aydin Arici, Yale University School of Medicine, New Haven, CT,
R. Pijnenborg, Dept. Obstetrics & Gynecology, University Hospital               USA
Gasthuisberg, B3000 Leuven, Belgium
                                                                                A fundamental requirement for successful implantation is that there must
Trophoblast invasion is an essential feature of haemochorial                    be a synchrony between the development of the embryo and the
placentation, in particular in the human where invasive behaviour is            conditioning of the uterus. Overall, estradiol and progesterone control
more explicit than in most other species with this type of placentation. In     the cyclic changes that occur in the endometrium in preparation for
our species this invasion is not restricted to the decidua, but is extended     pregnancy. These changes include production of paracrine factors such
into the inner myometrium.                                                      as cytokines and growth factors and recruitment of selected
Two pathways of invasion have to be distinguished: an interstitial              subpopulations of hematopoeitic cells relevant to implantation. Although
pathway in the decidual stroma and myometrium, and an endovascular              the maternal immune system has been viewed as antagonistic to
pathway into the spiral arteries, but not the veins. Interstitial invasion is   placental function, there is evidence that cytokines produced by uterine
performed by cytotrophoblasts, which are subsequently fused to                  cells promote trophoblast development. The number of cytokines and
multinuclear giant cells, which probably are no longer invasive.                growth factors expressed in the endometrium is remarkable and most
Endovascular trophoblasts on the other hand are not converted into              likely they are integrated into a vast and intricate network. We will
multinuclear cells, but their invasion seems to be restricted by their          review the ones that are believed to play important role in implantation
incorporation into a special “fibrinoid” extracellular matrix, deposited in     such as LIF, CSF, IL-1, and TGF-_. Leukocytes form a substantial
the arterial walls. During the process of incorporation the original            proportion of the constituent cells of human endometrium accounting for
smooth muscle layer and elastica are destroyed. While during the active         over 30% of the cells in early pregnancy. Large granular lymphocytes,
invasion process the endovascular trophoblast replaces the endothelium,         form the most abundant lymphoid cell population in endometrium in the
this is a temporary situation, which is followed by restoration of the          late luteal phase and early pregnancy. Their increase around the days of
maternal endothelium together with various degrees of intimal                   expected implantation, and their persistence in the first trimester of
thickening. The latter processes probably reflect maternal tissue repair        pregnancy followed by a rapid decline subsequently has suggested that
following the destructive action of invading trophoblast.                       these cells play a role in implantation and placental development. During
Basic research on trophoblast invasion mechanisms and their control has         its penetration into the decidua, trophoblasts elicit a response from the
been accelerated during the last decade. Expression of appropriate              maternal immune system as a result of its paternal antigens. Despite this,
adhesion molecules and secretion of proteolytic enzymes are essential           the pregnancy is capable of surviving in a host that is immunologically
characteristics of invasive cells. On the other hand, evaluation of             hostile, possibly due to the presence of a trophoblast-associated
possible restrictive properties of decidua and myometrium is also an            immunosuppressor factor. Recently we have obtained evidence that Fas
essential aspect of this research. It has also become clear that different      ligand expression on the trophoblast induces apoptosis of cytotoxic T
cytokines, secreted by maternal cells as well as the invading                   cells and may represent such an immunosuppresive factor. Other
trophoblastic cells themselves, play an important role in the coordination      placental factors that inhibit immune functions include progesterone, _-
of the extensive remodelling processes taking place in the placental bed.       fetoprotein, TGF-_, and IL-10. Trophoblasts selectively express antigens
                                                                                that are recognized by effector immune cells. They do not synthesize
                                                                                MHC class II antigens, but express an unusual class I molecule, HLA-G,
FM1.03.03                                                                       that exhibits limited polymorphism. Expression of HLA-G protects
ANGIOGENIC GROWTH FACTORS IN PREGNANCY                                          against killing by natural killer cells, and because of the relative lack of
Asif Ahmed. Department of Reproductive and Vascular Biology,                    polymorphism, HLA-G is not recognized as foreign by the maternal
Division of Reproductive and Child Health, University of Birmingham,            immune system. Finally, we have recently shown that homeodomains of
Birmingham Women's Hospital, Edgbaston, Birmingham, B15 2TG,                    maternal origin (i.e. HOXA 10 and HOXA 11 genes) regulate other
United Kingdom.                                                                 transcriptional activators and thus have crucial role in implantation.

Successful placentation requires a healthy placenta. Human placenta is a
highly vascularised organ that mediates gas and nutrient exchange               FM1.04.01
between the maternal and fetal circulations. Vascular endothelial growth        ANTENATAL ASSESSMENT OF THE FETUS
factor (VEGF) is a key agent in early placental angiogenesis. VEGF              M. Whittle, Academic Department of Obstetrics and Gynecology, The
acting in concert with placenta growth factor (PlGF), via two high              University of Birmingham, Birmingham, United Kingdom
affinity receptors VEGFR-1 and VEGFR-2, stimulates trophoblast
growth and migration as well as endothelial cell proliferation and vessel       Over the years the methods used to determine the fetal condition have
formation. A second class of receptor tyrosine kinase, Tie-2 receptor           changed markedly. In the 1970’s and 980’s the main thrust of evaluation
plays a role in vessel maturation. Angiopoietin-1 activates Tie-2 receptor      was through biochemical testing. These gave way gradually to
and angiopoietin-2 is the natural antagonist. Morphological studies             biophysical methods such as cardiotocography, ultrasound assessment
show poor placental vascular development and an increase in the mitotic         both of growth and wellbeing and most recently, Doppler waveform
index of cytotrophoblasts in intrauterine growth restriction (IUGR). We         analysis mainly of the umbilical artery.
hypothesised that the reported relatively high oxygen level in the              The evaluation of these tests in terms of their contribution to the delivery
intervillous space in contact with IUGR placental villi will limit              of babies in optimal condition has usually been inadequate. Firstly the
angiogenesis by changes in vascular endothelial growth factor (VEGF),           purpose behind the test, and whether it is to establish the presence of
placenta growth factor (PlGF) and angiopoietin-2 expression and                 hypoxia, poor growth or both, has not been explicit. Dissecting out the
function. Western immunoblot analysis demonstrates a diametric                  purpose of the test not only clarifies the situation for the person
expression of PlGF and VEGF proteins throughout pregnancy with PlGF             performing the test but allows the development of clearer end-points
levels increasing and VEGF levels decreasing, consistent with placental         which makes test evaluation more exact. In the era of biochemical
oxygenation. PlGF mRNA and protein is increased in IUGR as                      testing the end point used was usually only whether the baby was born
MONDAY, SEPTEMBER 4                                                                                                                                        9

alive or was small for dates. It is now apparent the many “small babies”        development of children. At 7 years of age, the significant association
may be perfectly normal and so much tighter criteria are required.              was found between abnormal fetal blood flow in utero and neurological
Secondly the patho-physiology of intrauterine demise is often unclear           impairment as well as less favorable results of psychological tests.
and yet the same tests of evaluation are used, with the same anticipation
of their value, in a whole variety of clinical situations. Thirdly there is a
distinct lack of good randomised studies, except for Doppler, available         FM1.04.04
for many of the tests which are in daily use. It is time to review the use      FETAL BIOPHYSICAL PROFILE
of antenatal monitoring and to re-evaluate its usefulness.                      Justo G. Alonso, Dept.OB/GYN, School of Medicine, Uruguay.

                                                                                Fetal well-being assessment by the biophysical profile (BPP), first
FM1.04.02                                                                       described by Manning in 1980, represents a conceptual milestone in fetal
ANTENATAL FETAL HEART MONITORING                                                medicine. With the assistance of real time ultrasound imaging, the fetus
YJ Meir, GP Mandruzzato, Dept. OB/GYN, "Burlo Garofolo" Hospital,               has become an object of direct clinical observation, and thus a real
Trieste, ITALY                                                                  patient.
                                                                                The fetus in its uterine environment shares some features in common
Antepartum Cardiotocography (CTG) is one of the few techniques                  with neonates (circadian rhythms, movement patterns, urine production,
available today to assess fetal conditions in high risk pregnancies. At         heart rate variability, etc.), but some are unique to the prenatal period
first continuous electronic fetal monitoring was used mainly in labor.          (breathing patterns, amniotic fluid, respiratory center responsiveness).
The principles of interpretation were based on this experience. With the        Direct clinical examination of a neonate is the best way to assess its
introduction of CTG, the identification of the distressed infant improved,      status. Similarly, real time observation of the fetus with the aid of
but various complications emerged for the obstetrician. The quantity and        ultrasound imaging is the closest we can get to clinical examination.
quality of information continuously produced required both constant             Besides, fetal heart rate monitoring, one of the five variables considered
attention and familiarity with the different CTG patterns for accurate          in BPP, renders valuable information concerning cardioregulatory center
interpretation. More recently, the CTG has been introduced as a method          oxygenation.
of antepartum fetal monitoring, especially in high-risk pregnancies. It         Therefore, 20 years after the first publication of the Fetal Biophysical
soon appeared that application of the intrapartum rules for CTG                 Profile scoring (BPP), this test - with small modifications - has been
interpretation was inappropriate antepartum; this added further                 time honored.
perplexities. Scoring systems were designed by several authors. Other           BPP has a very low false negative rate, which is its major advantage, and
authors tried to simplify interpretation by using descriptive terms as          low BPP scoring is a good predictor of fetal death. Also, association
"reactive" and "non reactive" or "normal, abnormal and pathological" or         between fetal venous pH determined by cordocentesis and each of the
"normal, suspect and ominous". The reliability of the test did not              five variables of the BPP has been established. Furthermore, it has been
improve significantly. Although several studies have reported good              suggested that it is a good predictor of the risk of cerebral palsy in
correlation between CTG data and perinatal outcome, reliable                    infancy.
assessment of CTG is by no means easy. Visual assessment of the                 However, randomized control trials comparing BPP with other methods
antepartum CTG, considered in isolation of other clinical data, has been        of fetal assessment have failed to render evidence in favor of the BPP.
shown to lead either to unnecessary intervention or to unwarranted              Nevertheless noninvasive and low cost methods for fetal assessment in
conservation in a large proportion of cases. The initial enthusiasm based       high risk pregnancies do not necessary have to compete. Neonates at risk
on the use of an instrumental test of fetal health was soon invaded by          are usually monitored intensively by several methods simultaneously
doubt due to its poor reproducibility. With the increasing number of            (oximetry, heart rate, respiratory rate, temperature, etc.), yet most of the
studies that recognized the lack of reproducibilty of visual evaluation of      techniques used regularly for neonatal assessment have not undergone
CTG, a numerical on-line analysis of FHR patterns was found essential,          trials to ascertain their efficacy.
not only for research, but as a more accurate tool in the assessment of         Therefore, rational utilization of all methods available for careful
fetal conditions. Since 1986 a computerized on-line CTG system entered          supervising the fetus at risk seems advisable. Amongst all known
clinical use in our Ob/Gyn Department in Trieste.                               methods, fetal Biophysical Profile is perhaps the most complete
                                                                                technique for fetal monitoring.

ANTENATAL DOPPLER ASSESSMENT OF THE FETUS                                       ON1.04.01
K. Marsal, Department of Obstetrics and Gynecology, University                  BREAST CANCER SURGERY: CURRENT APPROACHES
Hospital, Lund, Sweden                                                          M. Pricop, IVth Dept. OB/GYN, Gynecologic Oncology Division,
                                                                                University of Medicine and Pharmacy, Isai, Romania
In fetuses developing hypoxia-asphyxia, the Doppler velocity
waveforms in various vessels change in a characteristic way. In                 To appreciate the main aspects of the concept regarding the surgical
complications of pregnancy associated with increased resistance in the          treatment of breast carcinoma I’ll present retrospectively 560 cases with
placental vascular bed, e.g. intrauterine growth restriction the waveform       noninflammatory malignant breast tumors in different stage, which were
of the umbilical artery shows an increase in pulsatility index (PI) and         operated on in our Division of Gynecologic Oncology between January
eventually absent or reverse end-diastolic flow. Such finding is usually        1993 and January 2000.
associated with fetal hypoxia and signs of fetal distress. The concomitant      The surgical protocol consisted in various techniques, most frequently
finding of pulsations in the umbilical vein is associated with increased        beeing used radical modified mastectomy (197 cases) and simple
perinatal mortality. In Doppler traces of blood velocities recorded from        mastectomy with axillary dissection (176 cases).
the cerebral vessels of hypoxic fetuses, a redistribution of flow is            The breast cancer conservative treatment was practiced in 89 cases
reflected.                                                                      (16%). The main reason for its not beeing even more frequently usid is
The centralization of fetal blood circulation in hypoxia is reflected in        the lack of mammary screening in our region and, obviously, the small
changes in several vascular beds, which can be examined using color,            number of cases diagnosed in early stage.
spectral or power Doppler ultrasound. In the fetal middle cerebral,             Breast conservative surgery consisted of wide local resection with
adrenal and coronary arteries increased flow can be demonstrated. On            tumor-free margins. We agree with definition of negative margin as
the venous side of fetal circulation, both the inferior vena cava and           greater than 2mm rim of normal tissue. The orientation of the original
ductus venosus show late changes with decreased velocity during atrial          specimen is important to guide reexcision of positive marings. Breast
contractions. For practical clinical use, the Doppler velocimetry of            fresh specimens were sent at the time of surgery for frozen sections.
umbilical artery is most valuable due to the simplicity of examination          Reexcision was performed when margins were «positive» or «close».
and high predictive value of the pathologic findings. Especially, when          A lower axillary dissecion (AD) (level I and at least partialy, II) was
serial examinations are available, the change in the blood velocity             performed through a separate incision at the same time.
pattern can be used to time the delivery of the hypoxic fetus.                  All patients, independently of nodal status and age benefited from
The potential use of Doppler velocimetry in high-risk pregnancies is            radiation therapy.
supported by the follow-up studies relating the intrauterine                    We consider that AD should be almost systematically performed (cases
hemodynamic situation of fetuses and the postnatal neurological                 in which the method is not performed nust be carefully selected).
10                                                                                                                      MONDAY, SEPTEMBER 4

In our series the incidence of complications is much lower than those        gathered on detailed pharmacologic and pharmacokinetic differences
reported in other observations.                                              among these agents at the tumor level .
We are convinced about significance and efficacy of sentinel lymph
node identification but our experience in domain is reduced.
The therapy of node-negative cases is still subject of controversy. It may   RM1.02.01
be solved by making use of other categories of prognostic factors.           IN VITRO MATURATION OF OOCYTES.
We think that our practice, performed in not very modern conditions, is      Anne Lis Mikkelsen, Herlev Hospital, Herlev, Denmark
comparable with the same domain in other centers.
The results reported by the authoritative institutiions seem to be           Many attempts have been made to perform in vitro fertilization (IVF) in
reproductible in common practice.                                            the natural cycle without the use of exogenous gonadotropins. The
The treatment for breast cancer is no longer a simple surgical procedure.    combination of immature oocyte retrieval and in vitro maturation (IVM)
It is a multidisciplinary problem. The gynecologist is an important          may enhance the success of natural IVF. Although it is possible to
member of the team.                                                          mature and fertilize human oocytes in vitro the success rate in terms of
                                                                             live off spring after IVM has in general been low. There are several
                                                                             possible explanations for the poor developmental capacity of these
ON1.04.02                                                                    oocytes. One explanation might be suboptimal culture conditions during
TAMOXIFEN AND ITS GYNAECOLOGICAL CONSEQUENCES                                maturation in vitro, another might be that the oocytes themselves were
M. Kaufmann, Universitats-Frauenklinik, Frankfurt, Germany                   defective due to inadequate cytoplasmic maturation.
                                                                             While some studies have focused on improving culture media and
The partial estrogenic activity of tamoxifen leads to a stimulation of the   optimizing the time interval for maturation before insemination, others
endometrium with consequent development of pre-cancerous                     have tried to optimize the quality of the oocyte.
hyperplasias and endometrial carcinomas. The relative risk for users         Suggestions based on own and other data on normal, regular
compared to non-users has been determined between 2 and 4. However,          menstruating women:
these cancers are usually detected in early stages and do not have a         (1) Early priming with oestradiol gave a lower maturation rate and
detrimental outcome. The NSABP – P 1 prevention trial showed that this            impaired embryonic development compared to late priming with
risk is confined only to postmenopausal women. Vaginal ultrasound                 oestradiol.
scan was recommended previously for early detection of endometrial           (2) FSH priming did not have any effect on cleavage rate and embryo
changes. Due to a tamoxifen-induced edema of the subendometrial                   development.
stroma, endometrial thickening is often detected, but only atrophic          (3) Shortening the maturation period from 48 to 36 and to 30 hours did
endometrial tissue can be collected by D & C. By this routine ultrasound          not compromise the subsequent embryonic development
scan monitoring during tamoxifen treatment has lead to an unjustified        Timing of aspiration enhanced the pregnancy rate (clinical pregnancy
high number of unnecessary diagnostic invasive procedures. Patients          rate per aspiration improved from 13% to 23%).
become clinically symptomatic in most cases by vaginal bleeding similar      Immature oocyte retrieval combined with IVM may in the future be an
to non-tamoxifen induced endometrial cancer patients. Currently no           attractive alternative to conventional IVF. Besides the clinical effects of
endometrial screening is therefore recommended during tamoxifen              lowering side effects, especially elimination of hyperstimulation
treatment. However, in the case of vaginal bleeding in postmenopausal        syndrome, this treatment may reduce the costs of IVF. Women that
women careful diagnosis investigations are essential including               participate in IVM are not exposed to additional discomfort or risks than
endometrial tissue sampling.                                                 normally encountered with IVF treatment.

ON1.04.04                                                                    RM1.02.02
IN THE TREATMENT AND CHEMOPREVENTION OF BREAST                               D. L. Healy, Monash Medical Centre, Clayton, Australia
J. Bonte, UZ Sint Rafael - KULeuven, 33 Kapucynenvoer, 3000 Leuven,          Cryopreservation of embryos, oocytes and ovarian tissue represents a
Belgium                                                                      high priority in major programs of IVF and assisted reproductive
                                                                             technologies. Protocols for human embryo development,
Each new generation of aromatase inhibitors has offered improved             cryopreservation and thawing are now established in many IVF centres
characteristics compared with previous ones, third generation aromatase      with stble results. Wherever possible, patients should have treatment
inhibitors offering increased potency, specificity and better tolerability   aimed at cryo preserving their embryos. This is clearly the most
than the former compounds.                                                   effective way for them to have a baby in the future. Cryopreservation of
Based on the results of randomized phase III trials, third-generation        human embryos has now been successfully extended to cryopreservation
aromatase inhibitors (anastrozole, letrozole and exemestane ), have          of human blastocysts. By contrast, there is currently no method which
displaced progestins as preferred therapy for the treatment of hormone-      gives good survival of human oocytes. Very few ongoing pregnancies or
responsive metastatic breast cancer patients failing prior tamoxifen         live births have been achieved. It appears to reflect differences in cell
treatment. Compared with megestrol acetate, these agents offer               volume, membrane permeability, membrane composition, tolerance to
improved tolerability and similar or improved objective response rates       cryoproctetants and other as yet unrecognised factors. Rapid cooling and
and quality of life. Moreover, results seem to indicate a potential for      vitrification protocols have also proved effective in the mouse but have
improved survival, an outcome most consistently demonstrated by the          yet to be adapted to human oocytes. A male partner is not required. The
exemestane data, offering statistically significant improvements in Time     ovarian tissue can be collected by laparoscopy at anytime of the cycle
to Progression, Time to Treatment Failure and Overall Survival for the       from patients of any age. No hormonal treatments may be required as the
exemestane treated patient group. During less than 12 months of follow-      graft itself may support the processes leading to ovulation.
up, exemestane reduced the risk of death by 23% compared to megestrol        Disadvantages of ovarian tissue storage arise because the ovary can
acetate. Based on these encouraging results, research is currently           serve as a reservoir for infection and disease. In a mouse model, we have
underway or being planned to assess the role of these third-generation       demonstrated that frozen – thawed ovarian tissue from mice with
agents as first-line therapy, adjuvant therapy, and for the                  lymphoma transmitted lymphoma into grafted control mice. Ovarian
chemoprevention of breast cancer. Despite their similarities, there are      tissue storage for oncology patients should be undertaken in large
differences among the third-generation aromatase inhibitors. These           IVF/ART programs, with ethical approval and known protocols with
agents are more correctly categorized as aromatase inhibitors                attention to appropriate counselling and dignity for these particularly
(anastrozole, letrozole) or aromatase inactivators (exemestane) based on     vulnerable young women.
differences in their cellular mechanism of action.
Whereas aromatase inhibitors produce a reversible inhibition of the
aromatase enzyme, aromatase inactivators irreversibly inactivate
aromatase. These differences may have important implications in
determining optimal endocrine therapy for women with breast
cancer, issues that can be addressed only after more information is
MONDAY, SEPTEMBER 4                                                                                                                                      11

RM1.02.03                                                                        RM1.03.02
BLASTOCYST CULTURE                                                               HRT AND SERMS IN THE ELDERLY
W.S.B Yeung, Dept. OB/GYN, The University of Hong Kong, Hong                     A.R. Genazzani, M. Stomati, P. Monteleone, F. Bernardi, S. Puccetti,
Kong, China                                                                      B. Quirici, M. Liut, A. Tonetti, M. Gambacciani, Department of
                                                                                 Reproductive Medicine and Child Development, Division of
It is generally accepted that the culture condition for human embryo is          Gynecology and Obstetrics “P. Fioretti”, University of Pisa, Italy;
sub-optimal. Two methods have been used to promote the development
of human embryo to blastocyst in vitro. They are coculture of embryos            The brain is one of the specific target for sex steroid hormones. The
with somatic cells and use of different culture media for different stages       climateric withdrawal of estrogens, androgens and progesterone is of
of embryo development (sequential culture).                                      critical importance in determining mood, food intake, libido and
Coculture had received considerable interest in early 1990s. Various             cognitive changes. Through genomic and non genomic mechanisms
studies, including those from this laboratory, have shown that coculture         estrogens, androgens and progestins induce long- and short-term actions
improves the morphological development and implantation rate of the              by activating both specific intracellular receptors and non-specific
treated embryos. However, coculture involves complicated laboratory              membrane receptor by influencing gene transcription, synaptic
techniques and screening that are not suitable for routine use.                  functioning and electrical excitability. Estrogens exert a positive
With the development of sequential culture, blastocyst transfer has              influence not only on vasomotor instability but also on psychological
received considerable attention recently because of its simplicity and           disturbances like depression, sexual and affective disorders and
effectiveness. A problem with blastocyst transfer is that only                   cognitive function decline. In fact, estrogen modulates the
approximately half of the fertilized eggs continue to develop to                 noradrenergic, dopaminergic and opiatergic systems, thus controlling
blastocysts. Therefore, some patients may have no embryos available for          mood and behaviour in both animals and humans. Moreover, estrogen
transfer. Although failure of blastocyst formation in vitro may indicate         acts as a serotoninergic agonist by increasing serotonin synthesis and
lower oocytes, sperm or embryonic quality, it cannot exclude the                 levels of its main metabolite, 5-hydroxyndolacetic acid, thus improving
possibility that the current sequential media are still not yet optimal. It is   cognition.
certainly possible that some embryos that fail to reach the blastocyst           Another class of compounds, named selective estrogen receptor
stage in vitro would be able to do so in a better culture environment or         modulators (SERMs), exerts genomic effects on estrogen receptors in
would have given rise to offspring if transferred earlier.                       different ways from classical estrogens, acting as agonist or antagonist
Studies on methods of further improving the present culture system are           on target tissues. Among these compounds, raloxifene exerts specific
ongoing. With the use a human oviductal cell/mouse embryo coculture              antagonistic effects on a-receptors and agonistic effects on b-receptor in
system, we demonstrate that human oviductal cells improve the                    different brain areas. As an example of estrogen deprivation effects, in
development of mouse embryo in vitro by the production of at least 3             female rats ovariectomy significantly decreases the concentrations of
embryotrophic factors. The supplementation of these factors to the               allopregnanolone, a neuroactive steroid GABA-A receptor agonist, and
culture medium in future may enhance human embryo development as                 b-endorphin (_ -EP), an opioid peptide, in hippocampus, hypothalamus
well.                                                                            and pituitary. Estradiol or raloxifene analog antagonize these effects
                                                                                 when given alone, while given simultaneously, they do not induce any
                                                                                 significant changes in the hippocampus, hypothalamus and pituitary.
RM1.03.01                                                                        When raloxifene analog is administered in fertile rats, allopregnanolone
OVERVIEW: STRATEGY IN MENOPAUSAL THERAPY                                         and _ -EP levels became similar to those found in castrated animals.
D. W. Purdie, University of Hull, Hull, United Kingdom                           Androgens play a key role in female sexuality and libido. Their decrease
                                                                                 contributes to the decline in sexual interest experienced by many
The overall strategy in determining management should begin with the             women. Furthermore ageing processes are associated to a progressive
overall patient. Many women sail through the climacteric with no                 decline of circulating D5-androgens (dehydroepiandrosterone (DHEA)
discernible problem and many more regard this era as natural, bear its           and its sulphated ester (DHEAS)) since the third decade of life, reaching
symptoms with stoicism and reject the notion of treatment. The                   the lowest levels in elderly. Treatment DHEA and DHEAS is a potential
physician must determine if the stated complaints, clinical findings and         means of replacing androgens in older women. A remarkable
investigational results are consistent with menopause and if, in the             improvement in physical and psychological well-being has also been
patient’s opinion, they are materially affecting her personal, domestic or       observed following DHEA replacement therapy in early and late
professional wellbeing. If so, overall attention must first be given to any      postmenopause. The administration of 50 mg/day of DHEA determines
underlying disease and then also to any aspect of lifestyle such as diet         a significant increase in basal steroid hormone levels, except for cortisol
and physical exercise requiring adjustment. That done, attention should          levels that progressively decrease. DHEA restores basal plasma _ -EP
focus on whether or not the present symptoms and/or clinical signs are -         levels and the response to specific neuroendocrine stimuli (clonidine,
or are not - likely to be oestrogen-sensitive. If this is the case, then in      naloxone and fluoxetine). DHEA acts in the CNS both directly or
general terms, an appropriate HRT regime should be offered so that the           through its conversion into D4-androgens and estrogens, inducing effects
patient can exercise her right to accept or refuse. The physical symptoms        in several tissues, which can not be clearly attributed to DHEA or its
of oestrogen lack are well known and vary between populations. For               metabolites.
example, US women do not experience hot flushes, but hot flashes, a
criminal offence in the UK. The commonest symptoms of the
climacteric are tiredness, vasomotor symptoms, arthralgia, headaches             RM1.03.03
and insomnia into which careful enquiry should be made since they                MANAGEMENT OF UROGENITAL AGEING
carry a large differential diagnosis. Equally, the psychological symptoms        Prof. Jorge Tarzian Assistant professor of gynecology, Buenos Aires
such as irritability, loss of short term memory and depression have many         University, Argentina
causes and thus, when in doubt, a 12 week clinical trial of HRT is
indicated so resolution of the truly oestrogen-sensitive symptoms will           The urogenital tract changes generally start with the classic symptoms of
permit attention to be focused on the causation of the remainder.                menopause. It could be the emotional symptoms, the hot flashes or the
Patients should always be carefully apprised of the start-up effects of          shortness of breath. Many of these symptoms get better with time.
oestrogen exposure, such as mastalgia, calf cramps and rise in appetite,         However, the urogenital symptoms tend to intensify, and are generally
and of which are highly variable. No start-up effect should take any             related to the fall of estrogen.
patient by surprise. A review of the association between HRT and breast          These symptoms are often attributed to the decreasing size of the bladder
cancer using absolute risk - rather than relative risk - is mandatory. First     capacity, the hardening of the urethra with its consistent difficult
review should be at three months maximum when a decision to go, no-              displacement, and the decrease on the intraurethral vesical bladder.
go, or to divert to an alternative regimen can be taken. Duration of             We can observe a urinary frequency, residual urine in the bladder, and
treatment is individual and should last for as long as both physician and        detrusor muscle dysinergia.
patient believe that overall benefit is accruing to bone, brain or               Additionally, deficiency of estrogen produces decrease in the
vasculature. The use of amenorrhoeic preparations to avoid vaginal               proliferation and the maturation of the urogenital epithelium. A decrease
bleeding is to be encouraged as is further SERM development to supply            in the vascularity of the periurethral system and a loss of collagen
vasomotor symptom control in addition to bone conservation.                      produces a decrease in the tissue elasticity and the increase in the
12                                                                                                                           MONDAY, SEPTEMBER 4

vaginal ph. This results in a consequent loss in the protection of the            larger than following vacuum aspiration. The frequency of serious
urogenital tract to local infections.                                             haemorrhage requiring haemostatic curattage (0.8-1.9%) and the
It is possible that the motor activity in the urinary tract is directly related   frequency of blood transfusion (0.1-0.3%) are, however, similar to those
to the action of estrogen in the target organs and/or the nervous system.         reported for vacuum aspiration. Aslo the frequency of presumed pelvic
In animals where the ovaries were surgically removed, the treatment               infection requiring antibiotic treatment are the same following medical
with estrogen increased the contractility response to stimulation in the          abortion and vacuum aspiration. Side effects including uterine cramps,
bladder and the urethra. This is probably the result of stimulation of the        nausea and vomiting are more common amond the medical than the
alpha adrenergic receptors. Therefore, estrogen and alpha adrenergic              surgical abortion patients and occur mainly during the first hours
antagonists could be used as an experimental tratment for stress urinary          following prostaglandin administration.
incontinence in the post menopausal women.                                        If the women are allowed to choose both methods are equally
The low dose estrogens are ideal for the women with post menopausal               acceptable. Common reasons to prefer medical abortion are fear for
stress incontinence. In this manner estrogen can be administered orally           anesthesia and surgery and the procedure being less invasive and more
or vaginally in a way that would not produce post menopausal bleeding             natural. Adesire to be unconscious and therefor be unaware of the
due to the endometrial stimulation. With estriol and eventually with low          treatment and medical abortion being «to slow» are common reasons for
dose of estradiol, the effect is only local, that is only in the urogenital       women to prefer vacuum aspiration. All experience indicate that the
area. We can also recommend vaginal creams for prolonged periods or               medical method will not replace but be an alternative to vacuum
in short periods to improve the local tissues prior to reconstructive             aspiration. In Sweden both methods are equally often used. Which
surgery.                                                                          method is preferred in each individual case is depending on a variaty of
                                                                                  personal reasons and can only be decided by the woman herself in
                                                                                  consultation with her doctor.
William C. Andrews, Eastern Virginia Medical School, Norfolk, VA,                 RM1.04.02
USA                                                                               OTHER MEDICAL METHODS
                                                                                  L. Borgatta, Boston University School of Medicine, Cambridge, MA,
This lecture will present options for trating menopausal symptoms and             United States
for reduction of diseases of advancing age.
The first and most omportant of the options is lifestyle changes that             Note: At the time of writing, mifepristone had not been approved by the
improve health such as cessation of smoking, moderation of alcohol                United States Food and Drug Administration
consumption, and control of weight.                                               Several agents, developed and released for other indications, have been
Hormone replacement therapy (estrogen or estrogen/progestin) is the               used for medical abortion. These include methotrexate in combination
modality having the greatest potential of meeting both the objectives of          with misoprostol, and misoprostol alone. Other agents have been
treatment and prevention. Different regiments of dosage will be                   investigated but have not shown comparable efficacy to date.
discussed as well as the advantages and disadvantages of the various              Methotrexate/misoprostol has been used mainly in the United States and
delivery systems and schedules of administration. The choice is                   Canada, where mifepristone availability has been limited to clinical
influenced by the age of the patient, family history, physical condition,         trials to date. Both methotrexate and misprostol are inexpensive, stable,
as well as individual preference and should be tailored to the needs of           and widely available. Intramuscular methotrexate is used in the United
each woman.                                                                       States because it is the least expensive preparation; cost structure is
The reasons for the addition of androgen to hormone replacement                   different in other countries. Both oral (50 mg) and intramuscular
therapy will be discussed as well as the use of Tiolone.                          (50mg/m2 or 75 mg) routes have comparable efficacy. Vaginal
For women for whom hormonal replacement therapy is contraindicated                misoprostol (800 mg, used one or more times) has been used almost
or not desired, other options are available such as bisphosphonates or            exclusively.
SERMS for bone health or statins for coronary artery disease prevention.          Success rates (complete medical abortion without a suction procedure)
The increasing interest of women in alternatives such as nutritional              range from 88% to 98%. Where ultrasound was used for initial
supplements will b mentioned as well as the limited data available about          screening, the rate of continuing pregnancy is reported as 1 – 1.5%, but
their efficacy.                                                                   may actually be lower. Acceptability to women is high.
                                                                                  Misoprostol alone has also been used. Altough earlier trials indicated an
                                                                                  unacceptably high failure rate, current studies using 800mcg of vaginal
RM1.04.01                                                                         misoprostol show abortion rates over 90% in the first nine weeks of
FIRST TRIMESTER ABORTION WITH RU 486                                              pregnancy.
M. Bygdeman, K. Gemzell Danielsson, L. Marions, Karolinska Hospital,              For both methotrexate/misoprostol and misoprostol alone, the success
Stockholm, Sweden                                                                 rate is inversely related to gestational age. The type of medical practice,
                                                                                  expectations of the woman, and experience of the provider may also
A medical method for termination of early pregnancy has for long been             affect success rates. Rates of curettage for bleeding and incomplete
aimed at. Prostaglandin analogues were effective but side effects limited         abortion are ~ 1%.
their clinical usefulness. The development of antiprogestins, compounds
which interfere with progesterone at the receptor level, offered a new
possibility. However, it was only when demonstrated that treatment with           SS1.04.01
antiprogestin increased the sensitivity of the pregnant myometrium to             SITUATION ANALYSIS
prostaglandin and it was shown that the combined treatment effectively            Richard W. Steketee, Centers For Disease Control and Prevention,
terminated pregnancy, that a clinicaly useful method became available.            Atlanta, GA, USA
The medical method has been used routinely for around 10 years in
France, Great Britain, Sweden and China and is now or will soon be                Pregnant women in malarious areas may experience a variety of adverse
introduced in a number of other countries. In Great Britiain and Sweden           consequences from malaria infection through a cascade of events.
it is used up to 63 days of amenorrhea while in France and man other              Documented adverse consequences of malaria in pregnancy include
countries the upper limits is 49 days of amenorrhea. Up to 49 days, 600           peripheral parasitemia; maternal anemia; placental accumulation of
mg mifepristone (Exelgyne, Paris, France) in combination with 0.4 to              parasites; placental and peripheral blood immune stimulation with
0.6 mg misoprostol orally tends to be mostly used while in more                   cellular and cytokine responses; low birth weight (LBW) due to both
advanced pregnancies (50 to 63 days) mifepristone in combination with             prematurity and intrauterine growth retardation (IUGR); fetal parasite
1 mg gemeprost vaginally seems more effective. An alternative is                  exposure and congenital infection, and infant mortality (IM) linked to
vaginal administration of misoprostol, a possibility which is presently           preterm-LBW and IUGR-LBW. Through a review of recently published
evaluated in large multicentre sutdy organized by the World Health                and unpublished studies, we quantified the malaria population
Organization.                                                                     attributable risk (PAR) that accounts for both the prevalence of the risk
Both the medical and the surgical procedure, vacuum aspiration, are               factors in the population and the magnitude of the associated risk for
equally effective. Following the medical method, the patient will                 anemia, low birth weight, and infant mortality. Direct adverse
experience a longer period of bleeding and an amount of blood loss                consequences from anemia and human immunodeficiency virus (HIV)
MONDAY, SEPTEMBER 4                                                                                                                                 13

infection in these studies were also considered. PARs were generally         We will be discussing a number of cases. The cases cross issues such as
substantial: malaria was associated with anemia (PAR range=3%-15%),          HIV and reproductive technology, elective caesarian section, and
with LBW (8%-14%), preterm-LBW (8%-36%), IUGR-LBW (13%-                      making choices about fetal well being. The beginning of the first case
70%), and IM (3-8%). HIV was associated with anemia (PAR                     provided for your review:
range=12%-14%), with LBW (PAR range=11%-38%), and direct                     Mary is a 36 years old g2p1. Her first pregnancy was 3 years earlier
transmission to the newborn 20%-40% of the time with direct mortality        resulting in an uncomplicated normal vaginal delivery of a 3100 gram
consequences. Maternal anemia was associated with LBW (PAR                   girl. This pregnancy is a twin gestation diagnosed at 6 weeks of
range=7%-18%) and fetal anemia has recently been shown to be                 amenorrhera and confirmed at 12 weeks. Ultrasound shows tow distinct
associated with increased risk of IM (PAR not available). Overall, we        and probably dizygous placental sites. During a discussion about
estimate that each year 75,000 to 200,000 infant deaths are associated       amniocentesis, she indicates that she would seek fetal reduction if both
with malaria infection in pregnancy. The failure to use antimalarial         were girls. You proceed with amniocentesis and plan to tell her: A.
interventions is associated with substantial quantifiable adverse            Karyotype without sex B. Karyotype with sex C. Other plan.
outcomes — suggesting that incorporation of existing effective               We look forward to discussing these cases with you.
strategies into antenatal care programs in malarious areas is urgently

Edgar Dorman, Department of Obstetrics and Gynaecology, Homerton
Hospital, London E9 6SR, UK

The adverse effects of infection with Plasmodium falciparum in
pregnancy vary, depending on the immunity of the woman. Immunity is
determined by exposure to infection, and so varies with the intensity of
malaria transmission.
In non-immune women, infection is usually symptomatic and carries a
high risk of maternal and perinatal death. Particular risks are
hypoglycaemia, severe haemolytic anaemia, pulmonary oedema and
cerebral malaria.
In immune women (residents of endemic areas who are regularly
exposed to malaria) the infection is often asymptomatic. However,
severe and life-threatening maternal anaemia may result and low birth
weight deliveries are common, particularly in primigravidae. Co-
infection with HIV appears to increase the risk of malaria, regardless of
In all cases of symptomatic malaria in pregnancy, prompt treatment with
an effective antimalarial is essential. Severe disease should be managed
in an intensive care setting where possible, with maintenance of
normoglycaemia, transfusion for severe anaemia, and care to avoid fluid
overload. Quinine is the most appropriate drug in most circumstances
but in the face of parasite resistance, artemesinin derivatives may be
In endemic areas preventative strategies are necessary, as infection is
often asymptomatic and peripheral blood film may be negative. Where
the parasite remains sensitive, intermittent presumptive treatment with
sulphadoxine-pyrimethamine, given two or three times in pregnancy, has
been found to increase birth weight and to prevent 40% of cases of
severe maternal anaemia in primigravidae.
Avoidance of infection is ideal but, except in areas of very low or highly
seasonal transmission, insecticide-treated bednets alone do not provide
effective protection in pregnancy. They may have a role in reducing the
risk of re-infection after effective drug treatment.

SS1.05- SS1.06
J. Cain (1), J. Milliez (2),J. Schencker (3), (1) Pennsylvania State
University School of Medicine, Hershey, PA, United States, (2) Hôpital
St-Antoine, Paris, France, (3) Hadassah University Medical Center,
Israel, Jesuralem

You are about to venture into a world where YOU must take the
decisions about the “right” thing to do in difficult situations that we
encounter in practicing Obstetrics and Gynecology. We will be using the
audience response system – so we all will know how many of our
colleagues AGREE with our choices. Our distinguished panel will then
discuss the arguments for or against different choices and the practical
philosophy and ethics that underpin these choices, aided by other
members of the FIGO Committee for the Study of Ethical Issues in
Reproduction and Women’s Health. In fact, you will hear how the
committee “voted” on some of the same issues, often with a diversity of
opinion and thought. YOU can express your particular viewpoint or
reason for choosing one or another option as we discuss these choices in
14                                                                                                                     MONDAY, SEPTEMBER 4

FREE COMMUNICATIONS                                                          FC1.01.03
                                                                             AUDIT THE MANUAL VACUUM ASPIRATOR FOR THE
FC1.01 ABORTION                                                              MANAGEMENT OF INCOMPLETE ABORTION (1 000 CASES)
                                                                             AND TERMINATION OF PREGNANCY (3 000 CASES) IN A
FC1.01.01                                                                    TERTIARY CENTRE IN THE DEVELOPING WORLD
ARE INDUCED ABORTIONS A REALITY FOR WOMEN LIVING                             A. Daponte, G. Nzewanga, F. Guidozzi, Dept. OB/GYN, Johannesburg
IN SQUATTER SETTLEMENTS OF KARACHI, PAKISTAN?                                Hospital & Witwatersrand University, Gauteng, South Africa.
F.F. Fikree (1), S. Jamil (2)
(1) Population Council, New York, New York, USA.                             Objectives: To audit out management of incomplete abortion and
(2) Dept. Community Health Sciences, Aga Khan University, Karachi,           termination of pregnancy with the manual vacuum aspirator.
Pakistan.                                                                    Study Methods: Retrospective analysis of 1 000 consecutive incomplete
                                                                             abortion and 3 000 consecutive termination of pregnancy. Data were
Objectives: The aim of the study was to estimate induced abortion rate       retrieved from the patient’s files.
and investigate the perceptions and experiences of ever-married women        Results: There was one maternal death in the termination of pregnancy
regarding reasons for terminating an unplanned pregnancy and its             group (ectopic diagnosis missed).
associated morbidity, providers sought and abortifacients utilized.          Conclusions: Patient management was considered satisfactory. The
Study Methods: A cross-sectional survey was conducted in three               manual vacuum aspirator is a safe and cost effective method, which
squatter settlements of Karachi, Pakistan. The structured questionnaire      should be widely used in a day clinic set-up in the developing world
was organized in two modules conducted either for all respondents            after the health workers involved have been adequately trained.
(Module One) or limited to only those who reported ever opting for an
induced abortion (Module Two). Data were collected from 1,214
randomly selected ever-married women reporting at least one pregnancy.       FC1.01.04
Results: The abortion rate for the past year was 25.5 per 1,000 women of     OB-GYNS OPINIONS TOWARDS ABORTION IN ARGENTINA
reproductive age. The major perceived reasons for terminating an             S. Ramos, CEDES, B. Aires, Argentina, T. Durand, CEDES, B. Aires,
unplanned pregnancy were spousal unemployment (29.5%) and poverty            Argentina, M. Gogna, CEDES/CONICET, B. Aires, Argentina, M.
(20.7%) while actual reasons were short birth spacing (45.0%) and too        Petracci, CEDES, B. Aires, Argentina, M. Romero, CEDES/CONICET,
many children (15.0%). Mortality (34.4%) was the major perceived             B. Aires, Argentina, D. Szulik, CEDES, B. Aires, Argentina
post-abortion complication while heavy vaginal bleeding (57.3%)and
high-grade fever (51.7%) were post-abortion complications experienced        Argentina is in a transition regarding the promotion of reproductive
by the 100 index women seeking an induced abortion.                          health and rights. Still, there is no national family planning program and
Conclusions: The high induced abortion rate and its associated               the law regarding abortion is very restrictive. An inquiry on physician’s
complications illustrate the reproductive health burden of women in          opinions on these matters has become relevant due to the undergoing
these communities who tend to address their unmet need for family            public debate and policy innovations.
planning by opting for induced abortion.                                     Objectives: The study focused on: 1. Ob-Gyn’s agreement with abortion
                                                                             given different conditions and its depenalization; and 2. Ob-Gyn’s
                                                                             assessment of the quality of care provided to women with complications
FC1.01.02                                                                    from unsafe abortions.
FIRST TRIMESTER PREGNANCY TERMINATION WITH                                   Study methods: The study interviewed Ob-Gyns at public hospitals that
METHOTREXATE AND MISOPROSTOL                                                 serve low-income population in Buenos Aires. A self-administered
A.Papanicolaou, G. Makedos, D. Bantouva, N. Prapas, M. Goutzioulis,          anonymous questionnaire was applied. The response rate reached 84%
G. Vlassis, Aristotle University of Thessaloniki, 1 Agelaki str.,            (n=467). A bivariate analysis explored age and sex differences.
Thessaloniki, Greece, 54621.                                                 Results: 80% agreed with abortion in conditions such as: rape of insane
                                                                             women, woman’s health risks, and foetus malformations. Less than 14%
Objectives: The purpose of this study is to present the results of medical   agreed with abortion based on unwanted pregnancy, contraception
termination of pregnancy using methotrexate and misoprostol during the       failure, and/or lack of partner.
first trimester of pregnancy.                                                78.6% agreed that depenalizing abortion would decrease maternal deaths
Study methods: Prospective study of 35 women less than 50 days               due to abortion. 80% considered that law should not penalize abortion in
pregnant. 50 mg of methotrexate were administered at day 1, followed         cases of woman’s health risk, incest or rape, and foetus malformations.
by 800 ìg of misoprostol on day 7. Misoprostol was repeated on day 30,       Only 35% agreed on removing legal restrictions when abortion is based
if abortion was not complete. Patients were followed up by U/S and â-        on woman’s decision or adverse socioeconomic situation. Finally, 9%
hCG counts. The efficacy, toxicity and adverse reactions of the              considered that abortion should be penalized in all circumstances.
treatment are presented. Failure was defined as the need for a surgical      Regarding health care provided, 77% considered that women with
evacuation.                                                                  complications are always treated with medical competence; 22%
Results: 4 (11,4%) patients were unavailable for follow up. Mean patient     indicated women always receive contraceptive advice; and 12%
age was 29 years (18-45). Mean age of pregnancy was 45 days (range           indicated that women always receive psychological counseling. Finally,
35-50). Mean â-hCG was 33.456 U/l (range 516- 86,788). Bleeding              quality of care was perceived as good or very good by 76.4% of
started within 48 hrs after administering misoprostol. Gestational sac       respondents.
persisted at the day 8 scan in all but one patient and at day 15 in 5        Conclusions: The majority of Ob-Gyns agreed with pregnancy
patients (16%). Uterus was empty and â-hCG was normal in all patients        interruption and/or not penalizing abortion in the cases already
by day 30. Mean Hb values did not alter significantly during treatment.      contemplated by the law. There is still a group resisting abortion under
Most patients aborted by day 20 and 1/3 by day 9. 4 (12.9%) patients         any circumstances. A favourable assessment of care provided is made
warranted a surgical evacuation, 2 (6.4%) due to severe bleeding, 1          even when psychological counseling is often disregarded.
(3.2%) because of intolerable pain and 1 (3.2%) because of change in
mind. Cramping and pain were the most significant side effects. Failure
rate was 4/31 (12,9%).                                                       FC1.01.05
Conclusions: Medical abortion with MTX and misoprostol is a feasible         SECOND TRIMESTER PREGNANCY TERMINATION: A
alternative to surgical evacuation with a failure rate of 4/31(12.9%).       COMPARISON OF 600 AND 800 MICROGRAMS OF
                                                                             INTRAVAGINAL MISOPROSTOL
                                                                             Y. Herabutya, B. Chanrachakul, P. Punyavachira, Dept. OB/GYN,
                                                                             Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

                                                                             Objectives: To compare the effectiveness of 600 and 800 mg of
                                                                             misoprostol administered intravaginally every 12 hours for termination
                                                                             of second trimester pregnancies.
                                                                             Study Methods: One hundred and forty-three pregnant women at 14-26
                                                                             weeks’ gestation were randomized to receive 600mg (N=67) or 800mg
MONDAY, SEPTEMBER 4                                                                                                                                 15

(N=76) of intravagianl misoprostol every 12 hours until the abortion         delivery interval (10.2±6.2 hours vs 24.38±9.25 hours, p<0.001). Serum
occurred.                                                                    progesterone concentrations fell significantly following trilostane.
Results: The incidence of abortion within 48 hours after initial drug        Adrenal function was maintained within normal limits. Misoprostol and
administration were 92.5% and 92.1%, the mean abortion interval              analgesia requirements were lower with trilostane pretreatment. There
20.6±17.9 hours and 19.8±15.7 hours, the complete abortion rates 77.6%       was greater global satisfaction with treatment in the trilostance group.
and 72.4%, and the temperature of more than 38 degree Celsius 26.9%          The dose-finding study demonstrated that the lowest chosen therapeutic
and 71.1% (p£0.001) in 600 and 800mg groups, respectively. Other side-       regimen (total dose of 720 mg) was as effective as the higher doses (total
effects were similar between groups.                                         dose of 1080 mg to 2400 mg) but had fewer side effects. 3 women
Conclusions: We suggest that 600mg is the appropriated dose to be used       receiving trilostane were withdrawn from the studies: 1 due to facial
for second trimester pregnancy termination taking the effectiveness and      oedema and 2 because of vomiting following trilostance. There was 1
temperature into consideration. Shortening the dosing interval from 12       withdrawal in the placebo arm due to protocol violation.
hours to 6 hours remains to be investigated further.                         Conclusion: Trilostane has a potential therapeutic role in induction of
                                                                             midtrimester TOP. A low dose is effective and this therapy is acceptable
                                                                             to women receiving it.
INDUCED ABORTION AND CONTRACEPTION IN EUROPEAN                               FC1.01.08
PART OF RUSSIA                                                               VAGINAL MISOPROSTOL ALONE FOR MEDICAL ABORTIONS
E. Vikhlyaeva, E. Nikolaeva, S. Pavlovitch, T. Malanova, Research            UP TO 9 WEEKS OF GESTATION: EFFICACY AND
Center of Obstetrics, Gynecology & Perinatology, Moscow, Russia.             ACCEPTABILITY
                                                                             SW. Ngai, O. S. Tang, Y. M. Chan, PC. Ho, Dept OB/GYN, Queen
Objectives: The aim of the study was to investigate the trends in            Mary Hospital, Hong Kong, China
reproductive behavior and attitude to contraception in women after
induced abortion and labor.                                                  Objective: To investigate the efficacy of misoprostol (water added)
Study Methods: Two in-hospital populations, inhabitants of the 6             verses misoprostol (without water added) for first trimester medical
experimental territories of the European part of Russia, were included in    abortion in women with £ 9 weeks of gestation.
this multicenter epidemiological study – 1087 respondents (group A)          Study Methods: 80 women were randomly assigned to group 1 (water
tested after induced abortion and 1200 women after labor (group B) with      added to misoprostol) and group 2 (misoprostol alone). 800 ug vaginal
postdelivery counseling and following monitoring in 3-6-12 months.           misoprostol was given on day 1, 3 and 5. If the woman did not require
Results: The main determinants of reproductive behavior in two cohorts       vacuum aspiration during the period op to the return of first
of women are rather similar: early beginning of sexual activity – the age    menstruation after medical abortion, the outcome was classified as
of first sexual intercourse at the age of 13-19 years 70.2% in group A       complete abortion. The incidence of side effects and the acceptability
and 71.7% in group B; two and more sexual partners in history – 54.4%        were assessed through standardized questionnaire during and after the
and 51.4%. The time gap of ~4-5 years between beginning of sexual            abortion.
activity and marriage and first pregnancy (in 18-24 yrs) is 82.3% and        Results: The complete abortion rate was higher when water was added
76.1%, correspondingly, with predominant one-child family (75.7% and         but the difference did not reach statistical significance (85% vs 65%,
74.9%) and subsequent use of induced abortion as a main method of            p>0.05). Gastro-intestinal side effects were common but well tolerated
family planning. Barrier methods of contraception were used by               in both groups. Overall, 40% of women preferred surgical method in the
respondents of group A in 18.5% and 19.0% in group B, OC – in 10.4%          future because of the high failure rate.
and 9.5% and IUDs in 6.2% and 11.9%, correspondingly. The                    Conclusion: With the overall complete abortion rate of 85%, misoprostol
introduction of family planning services directly to the medical settings    alone is probably not a clinically acceptable method even if the addition
with subsequent longitudinal monitoring does reveal the noticeable           of water can improve the results. The addition of water onto misoprostol
changes of respondent’s attitude to modern contraception: during the         tablets does not improve its efficacy in first trimester medical abortion.
first postdelivery year the barriers were used in 33.1%, hormonal            Misoprostol alone is not recommended for medical abortion (up to 9
methods in 27%, IUDs – in 14.3%. The rate of induced abortion had            weeks of pregnancy) because of high rate and low acceptability.
been reduced with variations in experimental territories from 55.0 – 78.5
per 1000 women of fertile age in 1994 to 39.3 – 60.8 in 1998.
Conclusions: The lessons from conducted epidemiological study does           FC1.01.09
reveal two main groups of women at high risk of unplanned pregnancy –        SAFETY AND EFFICACY OF MISOPROSTOL IN SECOND
after induced abortion and labor. Implementing of the family planning        TRIMESTER MTP : A COMPARATIVE STUDY
services directly to the medical settings are actual measures for            M. Patel, S. Kadam, S. Khadilkar, S. Tayade, C. Purandare
prevention of unplanned pregnancies and reducing the rate of induced         Dept. OB/GYN, Grant Medical College, Mumbai, Maharashtra,India.
                                                                             Objectives: To study the safety and efficacy of Misoprostol
                                                                             (Prostaglandin E1) as compared to Extra-amniotic Ethacridine Lactate
FC1.01.07                                                                    combined with intramuscular Carboprost Tromethamine for second
INHIBITION OF PROGESTERONE SECRETION AS AN                                   trimester Medical Termination of Pregnancy.
INTERCEPTIVE STRATEGY                                                        Study Methods
S.K. Tregoning, P.M. Zinn, Z.M. van der Spuy, Dept. OB/GYN, Groote           A prospective randomised study was conducted in 400 patients divided
Schuur Hospital, Cape Town, South Africa.                                    in 2 groups, study and control of 200 each.
                                                                             M.T.P. in study group was done by using T. Misoprostol(200
Objective: Progesterone is central to the maintenance of pregnancy and       mcg)vaginally every four hourly.
is therefore the ideal target for fertility regulation and interceptive      M.T.P. in control group was done by extra-amniotic instillation of
therapy. In this study a 3-beta-hydroxysteroid dehydrogenase inhibitor,      ethacridine lactate followed by single dose of 1 ampoule injection
trilostane, was used to lower progesterone concentrations prior to           carboprost Tromethamine Intra muscularly after 6 hours.
misoprostol administration in the induction of midtrimester termination      Results: Mean gestational age was 17 weeks in study group and 18
of pregnancy (TOP).                                                          weeks in control group.
Study Methods: Women presenting for TOP at gestational age exceeding         With 24 hours cut off time success rate in study group was 97% and
13 weeks were recruited to a randomized controlled trial. They were          64% in control group which was statistically significant (p < 0.001).
treated with trilostane or placebo for 48-72 hours prior to administration   Mean induction- abortion was 11 hours in study group and 19 hours in
of misoprostol. End-points for the study included induction to delivery      control group .
interval, alterations in placental and adrenal steriodogenesis and           Side effects were minimal in study group as compared to control group.
acceptability of therapy. A further study was undertaken to assess the       Conclusions: Thus Misoprostol is very effective and safe agent for
efficacy of differing total doses of trilostane.                             second trimester termination of pregnancy as compared to extraamniotic
Results: 48 women were recruited to the first study. Compared to             instillation of ethacridine lactate
placebo, the trilostane group had a significant reduction in induction-to-
16                                                                                                                        MONDAY, SEPTEMBER 4

FC1.02 ADOLESCENT GYNECOLOGY 1                                                 Ten of them were reassigned as males (5 with PAIS and 5 with 5aRD
                                                                               deficiency). The rest continued adopting their female sex.
FC1.02.01                                                                      Conclusion: This interaction of nature versus nurture shows that in some
VAGINAL BLEEDING IN YOUNG CHILDREN                                             patients, endocrinology, presumably in the form of andorgens, has more
A.Aribarg, V.Phupong, Chulalongkorn University, Rama IV Road,                  effect on male gender identity than the sex in which the child has been
Pathumwan, Bangkok, Thailand, 10330.                                           reared, even in an unmalleable culture such as Egypt.

Objectives: To review our experiences with vaginal bleeding in young
children.                                                                      FC1.02.04
Study and methods: We analyzed the data of all children aged 10 years          THE LEVELS OF DHEAS, ESTRADIOL AND INSULIN IN 21
and under who were presented with vaginal bleeding and were under our          ADOLESCENT GIRLS SUFFERING FROM DYSFUNCTIONAL
care at the King Chulalongkorn Memorial Hospital between 1982 and              UTERINE BLEEDING
1999.                                                                          U. Radivojevic (1), G. Lazovic (2), T. Starovic-Medan (1), (1) Institute
Results: There were 55 girls presenting with vaginal bleeding with             for mother and child health care, A. Rudara 33, Belgrade, Serbia,
variable degrees of severity. In 41 of 55 girls (74.5%), bleeding resulted     Yugoslavia, 11070, (2) Institute of gynaecology and obstetrics, Clinical
from a local lesion of the genital tract. Genital tumors were seen in four     Centre of Serbia, Belgrade, Yugoslavia.
girls, i.e. hemangioma of the vulva, sarcoma botryoides of the vagina,
functional ovarian cyst and granulosa cell tumor of the ovary. In the          Objectives: Many patients with DUB have moderately elevated DHEAS
remaining 14 girls (25.5%), the bleeding originated from systemic              levels. It was suggested that some of the factors that may modulate
hormonal etiology. In one girl of precocious puberty, it was associated        adrenal production of androgens are estradiol, and insulin. The aim of
with hypothyroidism whereas in the other six girls it was due to               this study was to establish the levels of estradiol, DHEAS and insulin in
constitutional causes. In addition, 10 girls were due to vaginal               21 girls with DUB.
manifestation of leeches which is a unique problem for Thailand.               Study methods: Serum samples were obtained from 21 adolescent girls
Conclusions: Although vaginal bleeding in young children is rare,              for measurement of FSH, LH, insulin, DHEAS, testosterone,
serious underlying causes should be excluded. Prompt and correct               androstenendione, estradiol and progesterone levels. The quantitative
diagnosis will lead to successful management.                                  measurements of these hormones were performed by the use of
                                                                               radioimmunoassay procedures.
                                                                               Results: The mean levels of measured hormones in serum of 21
FC1.02.02                                                                      adolescent girls were: FSH-4.47+-1.07 IU/L, LH-11.42+-10.18 IU/L,
STRUCTURE OF THE OVARY IN ADOLESCENT FEMALES WITH                              insulin-245.72 pmol/L+-106.41pmol/L, testosterone-3.59nmol/L +-1.20
FUNCTIONAL DISTURBANCES WITH REGARD TO                                         nmol/L, androstenendione-6.93nmol/L +-4.15nmol/L, DHEAS-
PROGRESSIVE APOPTOSIS AND PREVALENCE OF                                        7.13mmol/L +-4.17mmol/L, progesterone-2.20nmol/L+-2,28nmol/L,
ANTIOVARIAN AUTOANTIBODIES                                                     estradiol 228.09pmol/L +-123.51pmol/L. In all patients anovulation was
J. Horejsi (1), J. Martinek (2), Z. Jirsova (2), Charles University, Prague,   detected. 7 patients had elevated levels of DHEAS, 8 had elevated
Czech Republic. Dept. OB/GYN, Institute of Histology and Embryology            insulin levels. Positive correlation was found between the levels of
                                                                               estradiol and DHEAS and between testosterone and DHEAS, while
Objectives: The aim of the study was to investigate the supposed               negative correlation was found between the levels of insulin and
influence of antiovarian autoantibodies (AOAA) in adolescents with             DHEAS.
primary (PA) or secondary amenorrhea (SA) structure of the ovary.              Conclusions: The results of this study indicate that elevated DHEAS
Study Methods: Antiovarian autoantibodies were tested in ovarian               levels found in adolescents suffering from DUB, can reflect action of
biopsies from 15 adolescent females with menstrual cycle disturbances          estradiol, on adrenal cortex, while the hyperinsulinemia was associated
using immunofluorescent-histological technique in both light- and              with normal DHEAS levels.
electron-microscopical level. Results were compared with circulating
FSH, LH, E2, PRL and progesterone. Ovaries were tested also using M
30 CytoDeath antibody for opoptosis detection.                                 FC1.02.05
Results: A higher incidence of AOAA was found in SA versus PA                  LOCAL IMMUNITY IN GIRLS AND ADOLESCENT GIRLS WITH
group. AOAA against thecal and lutein cells were estimated in almost all       CHRONICAL VULVOVAGINITIS
patients. In one case only the autoimmune oophoritis was confirmed. In         A. Sorkin, L. Matitsina, M. Sergienko, Dept. PED/AD GYN, Donetsk
SA group a pronounced fibrotization of ovarian cortex and other                regional center of Maternity and Child Protection, Donetsk, Ukraine.
follicular structure alterations were found.
Conclusions: Frequent incidence of AOAA in PA and SA adolescents               Objectives: In present time inflammatory process of genitals takes a
often influences negatively both function and structure of ovaries.            main place. Disorders in immunological parameters stipulate for
Study was supported by grant No. NH 5664-3 of Min. Health CR                   character of disease, time of its flow and also influence on the quality of
                                                                               diagnostic and treatment.
                                                                               Study Methods: This investigation was performed on 26 patients (girls
FC1.02.03                                                                      age 7-13 years) with chronical vulvovaginitis and diseases of internal
CLINICAL, ENDOCRINE AND GENETIC EVALUATION OF                                  genitals (chronical salpyngoophorytis).
TWENTY PATIENTS WITH MALE PSEUDOHERMAPHRODITISM                                Results: Immunological status in these patients evaluated till beginning
(MPH)                                                                          of treatment. Determine that on this stage level T-lmphosytes consist on
M.S. Ramadan (1), M. Hafez (2), F. El-Mougy (2), (1) Dept. OB/GYN              average 68,6±3,4% (range 69-85%), level b-lymphocytes 12,6±0,9% (in
and (2) Dept. of Endocrinology, El Galaa Teaching Hospital, DEMPU              normal 10-17%), fagocitarnal activity of neitrofils (NST-test for B.H.
Cairo University, Cairo, Egypt                                                 Park, 1968) on averge consist 1,4±0,1 (in normal and 1,20-1,52; 48,0-
                                                                               54,0%), the level Ig A consist on average 1,86±0,2 g/l (in normal 1,0-2,6
Objective: To study the effect of androgens on male gender identity on a       g/l); Ig G on average 12,07±1,96 (in normal 8,0-14,3); level Ig M –
child who has been reared as female in a group of MPH reared as                2,18±0,71 (in normal 0,8-1,4); the level Ig E in average 258,6±5,6 ng/ml
females.                                                                       (30-350 nmg/ml), CIC in average 81,6±2,9 (in normal 40-70). In all
Patients: Twenty patients (46XY) reared as female with an age range of         patients we investigate the level secritory Ig A in vaginal secrete and this
16 to 22 years presented with primary amenorrhea with or without signs         level consists on average 0,27±0,03 (was increased). In all patients the
of masculinisation.                                                            level of limphositis in peripheral blood was increased too and consists
Study Methods: Complete clinical, hormonal (including steroid                  44,2±4,6.
precursors at the basal state, following HCG & ACTH stimulation),              Conclusions: Thus, in girls with inflammatory disease of genitals mark
radiological, karyotyping, molecular genetic evaluation & psychosocial         increased levels of Ig M in serum of blood and levels of circulate
orientation.                                                                   immunological complex (CIC) and others immunological parameters.
Results: Two of them have complete androgen insensitivity (CAIS), 9            The received data have allowed to come to conclusion about efficiency
with partial androgen insensitivity (PAIS) 6 with 5a reductase                 of application of immmunological methods of investigation in girls with
deficiency (5aR deficiency) and 3 with leydig cell hypoplasia (LCH).           inflammatory disease of internal genitals.
MONDAY, SEPTEMBER 4                                                                                                                                   17

FC1.02.06                                                                    FC1.02.08
TEENAGERS WITH PUBERTAL UTERINE BLEEDING (PUB)                               N. Chophikashvili, J. Kirstesashvili, Dept. Reproductive Function
L. Sinenko, E. Yakovleva, L. Matitsina, Dept. PED/AD GYN, Donetsk            Formation, Zhordania Institute of Human Reproduction, Tbilisi,
regional center of Maternity and Child Protection, Donetsk, Ukraine.         Georgia.

Objectives: PUB is observed in 11-12% girl-teenagers with                    Objectives: The aim of the study was investigation of clinical and
gynecological pathology. The study of hormonal levels in girl-teenagers      hormonal peculiarities of hyperprolactinemia (HP) in adolescent girls.
with PUB, ultrasound investigation of internal genitals, comparison of       Study Methods: 150 medical histories with pubertal pathologies were
the results.                                                                 analyzed and 134 patients (age range 12-18 years) with HP and different
Study Methods: 78 girls with PUB at age of 10-18 were under our              reproductive disorders were examined. Gynecological, hormonal,
observation, who underwent the treatment in the department of child and      ultrasound, X-ray investigations were carried out.
adolescent gynecology. Clinical service included the definition of           Results: Most frequently in these patients HP had functional character.
hormonal level at the 21st day of menstrual cycle in the blood serum.        In 17 cases prolactinoma was diagnosed as well. According to our data,
Determination of the degree of sexual development according to mark of       pubertal HP had effaced clinical picture. Syndrome galactorrhea –
secondary sexual signs (SSS) and ultrasound investigation of internal        ammenorrhea was rare phenomenon. In most patients HP was associated
genitals.                                                                    with pubertal diencephal syndrome, secondary PCOS, disfunctional
Results: Hormonal levels were correlated with sizes of uterus, thickness     uteral bleeding, delayed sexual development. Prolactinoma was
of endometrium and SSS. All girls-teenagers with PUB were divided            characterized by significantly higher blood prolactin (PRL) level than
into three groups. The girls with thickness of endometrium from 1 to 5       functional HP. Basal PRL level in adolescent girls with prolactinoma
mm were composed in the first group (26 girls). The girls with thickness     was lower than in adults.
of endometrium from 5 to 10 mm – in the second group (26 girls), the         HP was frequently associated with elevated LH and normal FSH level.
girls with thickness of endometrium from 10 mm and over – in the third       In cases of hypophizal adenoma with very high level of PRL, low
group (26 girls). In girls of the first group testosterone level (t) – 4,8   concentration of FSH and LH was revealed. Normal serum cortisol and
nmol/l, Pr – 1,8 nmol/l, E2 – 1,4 nmol/l, sizes of uterus – 44,5 x 31,0 x    normal or increased testosterone levels were typical as well.
44,0; SSS – 9,7. In girls of the second group testosterone level (t) – 4,0   Conclusion: Clinical and hormonal characteristics of pubertal HP are
nmol/l; Pr –1,5 nmol/l; E2 – 0,11 nmol/l, sizes of uterus – 46,0 x 31,5 x    different from these characteristics in adults and represents as early stage
45,2; SSS – 11,0. In girls of the third group testosterone level (t) – 4,5   of HP syndrome.
nmol/l; Pr – 0,9 nmol/l; e2 – 0,18 nmol/l, sizes of uterus – 48,0 x 37,5 x   Timely, correct diagnosis and adequate treatment prevent the following
47,2; SSS - 9,0.                                                             aggravation of this disease.
Conclusions: Estradiol levels were low in the second and in the third
groups, progesterone levels were too low. Increase of thickness of
endometrium corresponded to the decrease of progesterone level.              FC1.03 CERVICAL SCREENING
Comparison of results confirmed the dysfunction of ovaries, indicated
the connection of progesterone level and estradiol level and thickness of    FC1.03.01
endometrium.                                                                 IMPROVING VISUAL INSPECTION AS A CERVICAL CANCER
                                                                             SCREENING OPTION THROUGH SEQUENTIAL TESTING
                                                                             P.D. Blumenthal and L.Gaffikin, JHPIEGO, Johns Hopkins University,
FC1.02.07                                                                    Baltimore USA, ZM. Chirenje, University of Zimbabwe, Harare
GENETICALLY DETERMINED DISORDERS OF SEXUAL                                   Zimabwe, J. McGrath, JHPIEGO, Baltimore, USA, T. Chipato,
DEVELOPMENT (GDDSD) IN ADOLESCENTS                                           University of Zimbabwe, K. Shah and S. Womack, Johns Hopkins
J. Kristesashvili, Dept. of Reproductive Function Formation, Zhordania       School of Hygiene and Public Health, Baltimore USA
Institute of Human Reproduction, Tbilisi, Georgia.
                                                                             Objective: The aim was to determine whether sequential testing could
Objectives: The aim of our study was detection of frequency of GDDSD         improve the usefulness of visual inspection as a screening option for low
in adolescents, elaboration of main diagnostic and treating principles.      resource settings.
Study Methods: 1852 medical histories have been analyzed and 248             Study Methods: HPV samples were obtained from 2,199 women as part
patients from them with GDDSD were investigated by us (age range 12-         of a larger (10,956) study evaluating the comparative performance of
18 years). During the research, gynecologic, genetic, hormonal,              visual inspection with acetic acid (VIA) and the Pap smear. 98% of the
ultrasound, X-ray, laparascopic and morphologic methods were used.           women screened with received colposcopy (and biopsy, as indicated)
Results: PCOS (multifactoral pathology) was diagnosed most frequently        which served as the reference standard defining true disease. Net test
– 120 patients (among them 43 family cases). 101 adolescents had             qualities of different sequential screening combinations were compared.
monogenic disorders: 85 – late onset form of adrenogenital syndrome          Results: With serial testing involving VIA followed by HPV, the net
(AGS) (16 family cases), 11 – androgen insensitivity (3 family cases), 5     sensitivity and specificity were 63.6% and 81.9% compared to 43.3%
– pure form gonadal disginesis (GD). Chromosomal pathologies were            and 91%, respectively, for the Pap smear followed by HPV. Individual
revealed in 27 patients; 3 of them had mixed form and 23 – typical form      test sensitivities for VIA, Pap smear and HPV were 77%, 44%, and
of GD.                                                                       80%, respectively. Specificities were 64%, 91% and 61%.
Rarest case with 45,X karyotype, small stature, typical Terner               Conclusions: For programs with limited resources but with the capacity
phenotype, regular menstrual cycle and normal sexual development was         for HPV testing, serial testing involving VIA and HPV would reduce the
described by us.                                                             number of women falsely identified as test positive compared to using
Treatment of PCOS and AGS was mainly pathogenic and symptomatic,             VIA as a primary test alone. False positive rates compared favorably to
directed to the normalization of menstrual cycle and regression of           those of the Pap/HIV combination and false negative rates were much
androgenization signs. Correction of growth and sexual development in        lower.
adolescents with GD was achieved by corresponding hormonal therapy.
All patients with mixed form of GD underwent gonadectomy.
Conclusion: Frequency of GDDSD in adolescents with reproductive              FC1.03.02
disturbances is high (19%). Complex clinical and laboratory                  CLINICAL RESULTS IN THE TREATMENT OF PELVIC
examination is necessary for correct and timely diagnosis and adequate       INFLAMMATORY DISEASE
treatment. Modern medical technologies (IVF, oocyte donation) give a         J. Skapinyecz, I. Smid, L. Rajnai, Dept. OB/GYN, Kenézy Hospital,
chance to improve reproductive prognosis and treat efficiently the           Debrecen, Hungary.
heaviest pathologies.
                                                                             Objectives: Sexually transmitted diseases (STDs) are the most common
                                                                             communicable diseases, and the incidence ahs risen over the past 2
                                                                             decades despite improved methods of diagnosis and treatment. Pelvic
                                                                             inflammatory disease (PID) is one of the most common serious
                                                                             complications of the current epidemic of STDs. The aim of the study
18                                                                                                                      MONDAY, SEPTEMBER 4

was to describe the clinical results in the treatment of hospitalized         Results: Incidence of abnormal gynoscopy finding was 8.8% and
patients suffering form PID.                                                  abnormal Pap smear was 6%. Gynoscopy was found to have sensitivity
Study Methods: A retrospective study 622 patients with different clinical     of 80% and specificity of 95.7% as compared to Pap smear. Fifty
stages of pelvic inflammatory diseases was undertaken during the 10           percent correlation was noted with histopathology when either Pap
years period from the 1st of January 1990 to 31st December 1999. The          smear or gynoscopy was abnormal while 84% correlation was noted
management of PID has been made by setting 3 objectives: treatment of         when both the tests were abnormal.
infection, alleviation of sypmtoms, and prevention of complications.          Conclusions: Gynoscopy is an inexpensive, easy to use portable system,
After having a correct clinical diagnosis for PID, an established empiric     which can be used to screen for cervical abnormalities as out patient
antibiotic therapy was started immediately, and it was followed by other      department procedure in any setting. It is an useful alternative method
antimicrobial combination – if needed –according to the culture results.      for mass screening especially in developing countries where Pap smear
Patients were treated for PID by different regimens according to the          facilities are not adequate available in all parts of the country. Where
severity of the disease. The clinical results of medical treatment and        facilities are available, combining gynoscopy with pap spear increases
surgical intervention were investigated in different clinical stages of the   the positive predictive value of screening.
Results: Of the 622 patients medical treatment alone was effective in
62% and there was a need for surgery in 38%. Surgical intervention was        FC1.03.05
reserved for patients with acute abdomen, ileus, rupture of tuboovarian       DOWN STAGING OF CERVICAL CANCER – A STATEGY FOR
abscess, and for those who failed to respond to antibiotic therapy. The       DEVELOPING COUNTRIES
clinical cure rate with only medical therapy was found 97.3% (286/294)        U. Saraiya, Cytology Clinic Cama and Albless Hospital, Mumbai, India.
in mild cases, 49.2% (92/187) in moderate cases and 4.2% (6/141) in the
severer cases.                                                                Objectives: To evaluate the role of Clinical Down Staging of Cervical
Conclusions: Immediate and appropriate antibiotic therapy alone, can          cancer in India.
lead to good clinical results only in patients with mild PID.                 In India Cervical Cancer continues to be a major health problem.
                                                                              Although cytology services are developing, they are not adequate to
                                                                              cover the vast population.
FC1.03.03                                                                     Down Staging by regular visual inspection, unaided and aided and use of
OUTCOME OF WOMEN OVER THE AGE OF 50 YEARS                                     a magnifying lens are modalities which will eliminate late cases and lead
REFERRED FOR COLPOSCOPY AFTER A FIRST EVER                                    to diagnosis of Stage I & II cases.
ABNORMAL SMEAR                                                                Study Methods: Maharashtra, a state with a population of 65 million has
V.Brown, J.Panikkar, S.Jivraj, M.Dass, Jessop Hospital for Women,             introduced down staging as and Interim Strategy to control cervical
LeavyGreave Road, Sheffield, South Yorkshire, United Kingdom, S3              cancer.
7RE.                                                                          Results: Multi-centric studies carried out in various parts of the county
                                                                              give a variable but acceptable sensitivity and specificity rates.
Objectives: To determine the incidence of high grade CIN and                  In the meantime, teaching and training of Personnel for Pap Smear is
carcinoma in women over 50 years of age, with a normal smear history,         going on at an accelerated rate and Colposcopic evaluation of all women
referred for colposcopy following an abnormal cervical smear.                 with abnormal smears is undertaken. Suitable treatment is given so as to
Study Methods: The NHS(U.K.) cervical screening programme                     prevent Invasive Cervical Cancer.
recommends cervical screening until the age of 64 years. Several authors      Conclusions: Indian experience indicates that Down Staging by visual
have suggested that women over 50 years, who have participated in the         inspection is a suitable strategy for developing countries.
screening programme and with a history of normal cervical cytology, no
longer require this screening.
A retrospective case note analysis was performed of women over the age        FC1.03.06
of 50 years attending a teaching hospital colposcopy clinic between april     CLINICOPATHOLOGICAL AND COLPOSCOPIC STUDY,
1995 and June 1999. The cervical smear history, any previous CIN, the         AN EFFECTIVE METHOD IN DOWN STAGING OF CARCINOMA
final diagnosis and treatment of these women were determined.                 CERVIX
Results: 2645 women were referred for colposcopy in total during this         G. Ganguli, S. Tandon, K. Mukherji, M. Dayal, Department of
time. 212 women (8%) were 50 years or over and were referred for              Obstetrics and Gynaecology, M.L.N. Medical College, Allahabad, India
colposcopy because of an abnormal cervical smear. 26 (12%) had a
previous history of CIN. One hundred and twenty three women (58%)             Cervical cancer is a commonest situation for primary malignant disease
reported regular screening with no previous smear abnormalities. Of this      and leads to significant mortality and morbidity when advanced.
group, 27% histologically proven CIN, 16% having CIN II or III.               AIMS:
Thirteen women (11%) had CIN I. A further 2 had invasive carcinoma.           (1) To teach paramedical staff of family welfare units about
In total, 28% of this group of previously screened women had significant           perspeculum examination and early referral of suspicious cases to
cervical pathology.                                                                apex centres.
Conclusions: In the light of these findings we feel that it would be          (2) To evaluate the diagnostic efficacy of perspeculum examination,
unwise to discontinue routine cervical screening in women over 50 years            cytology, colposcopy and histology in detection of early cervical
of age with a normal smear history.                                                cancer, for down staging of cervical cancer.
                                                                              Study methods: This prospective study was carried out on 416 patients
                                                                              seen in KNM Hospital and SRN Hospital Allahabad. Patients were
FC1.03.04                                                                     studied by detailed history, systemic examination, speculum
ROLE OF GYNOSCOPY AS A VISUAL CERVICAL SCREENING                              examination and vaginal examination. Pap smear was done in all
TOOL FOR DETECTING ABNORMALITIES OF UTERINE CERVIX                            patients. Coloposcopy was done in 162 patients and cervical biopsy
S. Mittal, N. Vimlamma, S.K. Jain, V. Dadhwal, Dept. OB/GYN, All              could be done in 91 patients only.
India Institute of Medical Sciences, New Delhi, India.                        Results:
                                                                              · Maximum number of CIN patients were Hindu (73.39%) belonging to
Objectives: To evaluate the Role of Gynoscopy as a visual cervical               low socioeconomic status (72.39%) had mean parity of 3.51, mean
screening tool in comparison with cervical cytology (Pap smear).                 age at marriage in study group was 19.28+ 3.18 years, but in CIN
Study Methods: In a prospective clinical study 500 women in                      patients it was 16.11 + 3.26.
reproductive age group were subjected to naked eye per speculum               · On cytological screening CIN were seen in 11.05% cases, and
examination, followed by examination through a simple hand held lens             invasive cancer in 0.48% cases.
called gynoscope with a magnifying power of +4D, both before and after        · On colposcopy atypical transformation zone was seen in 23.43%.
application of 3% acetic acid. The findings were noted and compared           · Cytohistological co-relation was possible in 87.9% cases, false
with the result of Pap smear taken at the end of procedure. Colposcopy           negative and false positive results were 7.6% and 5.49% respectively.
and directed biopsy were done in women who had either abnormal                Conclusion: By naked eye visualization, cytology and colposcopy and
gynoscopy or abnormal Pap smear and the results were correlated.              biopsy, no risk of overdiagnosing or missing any lesion as all are
                                                                              complementary thus helpful in down-staging of cervical cancer.
MONDAY, SEPTEMBER 4                                                                                                                                    19

FC1.03.07                                                                      FC1.03.09
ANALYSIS                                                                       ACID
L.Gaffikin, J. McGrath, Y.Chen and P.D. Blumenthal, JHPIEGO Corp.,             P. Hillemanns, H.Weingandt, R.Baumgartner, H.Stepp, Univ. Munich,
Baltimore, MD, USA                                                             Marchioninistr. 15, München, Germany, 81377.

Objectives: The aim was to determine whether clinical-history based risk       Objectives: The aim of the study was to examine the diagnostic potential
factor analysis would improve the usefulness of visual inspection using        of porphyrin fluorescence in patients with CIN 1-3.
acetic acid (VIA).                                                             Study Methods : Besides cytology, HPV testing and colposcopy, 68
Study Methods: A clinical history was obtained on 2206 Zimbabwean              women of our colpo clinic received 10 ml 0.5 or 1.0% 5-aminolevulinic
women using a standardized questionnaire prior to VIA testing. All             acid (5-ALA) topically. After 30 - 360 minutes, real-time image analysis
women also underwent colposcopy (and biopsy, as indicated), the                and spectroscopy from 685 sites were performed.
reference standard defining disease. Bivariate analysis identified             Results: Due to rapid photobleaching, 0.5% 5-ALA was ineffective for
singularly significant predictors of disease and multivariate regression       photodetection. Using 1% 5-ALA, fluorescence intensities correlated
analysis identified significant predictors adjusting for the presence of       with incubation time, however, fluorescence contrast showed a
other factors. Test quality analysis involving subgroups of women with         maximum at 60-90 min (ratio 11:1). HPV DNA positive lesions showed
signficiant risk factors revealed how limiting the screening population        a significantly higher fluorescence. Fluorescence imaging after 60-90
affects VIA’s performance.                                                     min achieved similar sensitivity and specificity compared to colposcopy
Results: 23 variables were singularly significantly associated with            (94% and 51% versus 95% and 50%, resp.). However, the specificity
disease. Multivariate analysis yielded only three independently                was markedly improved by fluorescence spectroscopy achieving 75%.
signficant risk factors: age, marital status and STD history. The positive     The evaluation of spectral measurements revealed significantly higher
predictive value (PPV) was signficantly higher among women with three          values for CIN compared to normal tissue, and for CIN 2/3 compared to
risk factors as compared to the whole group (30% vs 18%, respectively).        CIN 1 (p < 0.001).
Sensitivity also improved from 77% to 86%. PPV was signficantly lower          Conclusions: Using a time interval of 60-90 minutes after topical
among women with none of the three risk factors (6%).                          application of 1% 5-ALA, specific porphyrin fluorescence of CIN was
Conclusions: In settings where Pap smears are cost- or resource-               observed. Fluorescence spectroscopy promises to become a valuable tool
prohibitive, VIA is a low cost alternative with relatively good                for the diagnosis of CIN.
sensitivity. The probability that a woman testing positive is indeed
diseased can be maximized by focusing testing towards those known
through clinical history-based risk factor analysis to be at highest risk of   FC1.04 CESAREAN SECTION 1
                                                                               ANALYSIS OF CAESAREAN SECTION RATES USING THE
FC1.03.08                                                                      ROBSON 10-GROUPS
SCREENING FOR CERVICAL NEOPLASIA BY SELF-COLLECTED                             D. Keane, National Maternity Hospital, Dublin, Ireland and M. Robson,
SAMPLES TESTED FOR HUMAN PAPILLOMAVIRUS DNA                                    Wycombe General Hospital, High Wycombe, U.K.
P.Hillemanns, C.J.Thaler, U.Hüttemann, R.Kimmig, Klinikum
Grosshadern, Univ. Munich, Marchioninistr. 15, München, Germany,               Objectives: National and international caesarean section (CS) rates vary
81377.                                                                         from institution to institution. The aim of this study was to compare the
                                                                               indications for CS between four hospitals in different countries using the
Objectives : The aim of the study was to evaluate self-collected vaginal       same method of classification.
samples tested for HPV DNA as a method for cervical cancer screening           Study Methods: The CS rate in each hospital was subdivided into the ten
and to compare it with the speci-mens taken directly from the cervix           groups as first described by Robson et al. Each of the hospitals
uteri by the doctor.                                                           concerned has been using this method of classification for over six years
Study Methods : In this study, 247 women of our colpo clinic were              and it forms part of their monthly audit.
asked to introduce a HPV cyto-brush into the vagina and place it into the      Results: The analyses of the groups show wide fluctuations in the CS
specimen collection tube. Cytology, HPV testing (Hybrid Capture II)            rate of both spontaneous and induced labours, for both nulliparous and
and colposcopy was performed by the doctor.                                    multiparous patients. In addition the CS rate in patients with one
Results : HPV positivity was present in 53% of the patients´ brushes as        previous CS, and the CS rate in breech presentation indicate an
opposed to 42% of the specimens collected by the clinician (p < 0.01).         increasing trend in some countries towards elective section in these
High-risk HPV types were more often detected in the self-samples               groups. Trends in each hospitals figures over six years will also be
(47%) than in the clinicians´ cervical brushes (38%; p < 0.05). Biopsy-        demonstrated.
proven CIN 1-3 was diagnosed in 56 (23%) women, 38 (15%) thereof               Conclusions: The classification of CS rates shown indicates a method
presented with high grade CIN 2/3, two had invasive cervical cancer.           that is reproducible and easily applied to all units. This allows for
The sensitivity of the high-risk HPV types for CIN 1-3 was 86%                 international comparison between hospitals, which has been lacking in
compared to 80% for the physician directed samples. For CIN 2/3 and            previous comparative studies. The main thrust of this classification
cancer, same sensitivities of high-risk HPV of 93% for the two sampling        serves not to highlight one’s CS rate and whether it is high or low, but
methods were noted. Three (8%) CIN 2/3 lesions would have been                 instead to know why the rate is what it is.
missed by either one of the sampling methods.
Conclusions : Self-sampling seems to be a reliable method for HPV
testing and, more important, for cervical cancer screening. In developing      FC1.04.02
and, perhaps even in countries with cytology screening, self-assessment        PROLONGED OBSTRUCTED LABOR AS A MAJOR CAUSE OF
can be advised as cost-effective primary screening.                            POSTPARTUM HEMORRHAGE
                                                                               K.Kyei-Aboagye, O.Vragovic, G.Kaufman, P.Stubblefield, Boston
                                                                               University School of Medicine, 93 East Concord Street, MAT 3, Boston,
                                                                               MA, United States, 02118.

                                                                               Objective: To identify preventable intrapartum causes of cesarean
                                                                               section (C/S) associated postpartum hemorrhage (PPH) eg. duration of
                                                                               labor. Materials and Methods: We reviewed all 5,885 deliveries from
                                                                               1/1/96 -7/30/98. PPH was defined as either the need for transfusion or
                                                                               10% change in hematocrit. Of the 1,184 gravidae delivered by C/S, 306
                                                                               (46% of all PPH) were due to failure to progress; 255 of these were for
                                                                               cephalopelvic disproportion (CPD) of which 38 suffered PPH. They
                                                                               were compared to all the gravidae who delivered at the same period with
20                                                                                                                      MONDAY, SEPTEMBER 4

respect to age, race, and prenatal characteristics, medical complications,   elaborate on the intra-operative surgical management and the peri-
gestational age, indications for C/S, complications of labor, type of        operative haematological surveillance.
anesthesia, and infant birth weight. Furthermore, there were 21 cases
with both CPD and PPH. Consequently, ten patients who could be
perfectly paired matched with those who had CPD without PPH were             FC1.04.05
compared as above using a paired t-test.                                     THE PREVALENCE OF ETILOGY OF CESAREAN SECTION IN
Results:                                                                     TERM PREGNANT WOMEN IN MEYBOD HOSPITAL
Total deliveries        5,885                                                R. Taheripanah, Dep OB/GYN Avesina Research centre. Shahid
C/S                     1,184                                                Beheshti University, Evine Street.Tehran, Iran
CPD                       255                                                M.A. KARIMZADEH, Dept. OB/GYN. Shahid Sadughi Medical
C/S + PPH                  38                                                University. Mahdieh Cross, Madar Hospital, Yazd. Iran
C/S + CPD + PPH            21                                                F, Karami. Obstetric part. Shohada hospital, Meybod, Iran
The matched pair results show that gravidae with CPD who had PPH at
C/S had the mean duration of labor of 19.7±6.3 hrs compared with that        Objective: The aim of this study is to point the incidence rate of cesarean
of those without PPH of 11.4±5.4 hrs (P < .004). In addition, twenty-        section in comparison with normal vaginal delivery among pregnant
nine mothers who were clinically determined to be carrying large fetuses     women.
and were delivered by elective C/S, had no PPH (mean birth weight of         Study Method: In this prospective cross-sectional study, 721 pregnant
4,236±212gms).                                                               women that admitted in Meybod hospital for delivery for one year (since
Conclusion: Our results lead us to conclude that gravidae who actively       21/11/1998 till 20/11/1999) were participated. Demographic information
labor for over 16 hours before the establishment of the diagnosis of CPD     was asked and was written in their records. Beside the manner of the
are more likely to suffer PPH.                                               previous section, babies and interval between last delivery were notified.
                                                                             Results: Among 721 patients who were studied 220 patients were under
                                                                             gone cesarean section (28.5%) and 501 remaining patients gave normal
FC1.04.03                                                                    vaginal delivery (71.5%).The most prevalent reason of cesarean section
EMERGENCY CAESAREAN SECTION: AN ANALYSIS OF                                  is dyctocia (31.8%) and the second cause was the previous cesarean
MATERNAL AND FETAL OUTCOME                                                   section with 24%incidence. The most prevalent reason in cesarean
M.L. Yeap, K.H. Tan, C.S. Tee, S.H. Yeo, Dept of Maternal Fetal              section termination of pregnancy among primigravida patients was
Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah                dyctocia and fetal distress (76%). Where as other patients especially
Road, Singapore 229899.                                                      gravida II was the previous cesarean section.
                                                                             Conclusion: In order to obtained statistics information it is determined
Objectives: To analyze the indications and maternal-fetal outcome of         that cesarean section and in order to with due attention to decrease
emergency caesarean sections.                                                cesarean section rate, we should perform vaginal delivery after cesarean
Study Methods: A retrospective review was conducted on 114                   section (VABC). Other wise the cesarean section rate due to repeat
consecutive emergency caesarean sections performed over a one-year           cesarean section not only no decreases but also increases in a high rate
period between May 97 and April 98 in KK Women’s and Children’s              Therefore, efforts to lower cesarean section rates of individual
Hospital, Singapore. This accounted for 3.8% of the 3,371 caesarean          practitioners should focus on the areas of fetal distress, cephalopelvic
births and 0.7% of the 16,267 total deliveries.                              disproportion, and repeat cesarean section and without using of VABC
Results: The mean age of patients was 30.4 years with gravidity of 2.3       the rate of cesarean section will not reach to gold standard of 15% in
and parity of 0.9. The mean gestational age was 37.5 weeks (range 27 to      year 2000.
43 weeks).
Fetal bradycardia (39.0%), fetal distress (15.8%) on cardiotocography,
cord prolapse (17.5%) and abruptio placenta (14.0%) were the                 FC1.04.06
commonest indications. The duration between decision for surgery to          EARLY POST-CAESAREAN DISCHARGE FROM HOSPITAL
actual delivery averaged 14.9 minutes.                                       B.R. Choudhury, Dept of OB/GYN, Sir Salimullah Medical College
The mean post-operative stay was 4.5 days (2 to 16 days). Major              Hospital, Dhaka, Bangladesh
complications include postpartum hemorrhage (3), bladder injury (1),
uterine tear (4) and disseminated intravascular coagulation (2). Minor       Objectives: Our purpose was to assess early post Cesarean discharge
complications were urinary tract and superficial wound infections and        from hospital.
superficial cuts on the babies.                                              Study Methods: A prospective study was done among 376 patients
The mean APGAR scores was 7.1 and 8.3 at 1 and 5 minutes                     having Cesarean delivery in one the three maternity units of OB
respectively. Three babies, all in the abruptio group, had poor APGAR        department of SSMC & Mitford Hospital from 1st MAY 1999 to 15th
scores (< 4 at 5 minutes), of which 2 died.                                  November 1999. Among them, 121 women were discharged from the
Conclusions: With good multi-disciplinary support for a emergency            hospital earlier between 2nd and 4th POD. All study cases were advised
caesarean section, obstetric emergencies can be well managed with            during discharged to attend the GOPD for stitch removal and for check-
minimal maternal and fetal risks.                                            up and management if any complications occurred. The details of
                                                                             patients’ records were studied and different parameters were evaluated.
                                                                             Results: A total of 376 women underwent Cesarean delivery in one
FC1.04.04                                                                    maternity unit of the stated hospital during the study period. Within this
CAESAREAN AND POST-PARTUM HYSTERECTOMY – AN                                  population, 121 (32.18%) met the inclusion criterion and agreed for
OVERVIEW                                                                     early discharge from the hospital. In the control group remaining, 255
N Khenyab, N Ali, B Ahmed and H Fawzi, Women’s Hospital, Hamad               (67.82%) who were also underwent Cesarean deliveries during the same
Medical Corporation, Doha, Qatar.                                            period.
                                                                             Conclusions: On the basis of our data and experience among properly
Objective: To identify the demographic characteristics, indications,         selected candidates, early post Cesarean hospital discharge is a
operative procedures and complications for caesarean hysterectomy and        reasonable option. Because our maternity units are over crowded with
postpartum hysterectomy.                                                     post-Cesarean patients. Sometimes 2 patients are kept in a single bed,
Method: A retrospective review of women who had undergone                    which also increase the risk of infection, also increase cross infection of
caesarean or postpartum hysterectomy in the period 1 January 1996 to         newborns. A board policy of early post Cesarean hospital discharge may
31st December 1998.                                                          be adopted by our Obs. Overall, it will reduce hospital cost and cost of
Setting: The Women’s Hospital – Hamad Medical Corporation, Doha,             patients and increase patients turn over.
Discussion: Obstetric Hysterectomy is a rare potentially life-saving
surgical procedure in spite of its associated intra-operative risks and
post-operative complications. The presentation will overview the
demographic details and indications for caesarean hysterectomy. It will
MONDAY, SEPTEMBER 4                                                                                                                                   21

FC1.04.07                                                                      FC1.04.09
OF OBSTETRIC CARE                                                              M. Gandhi, Dept. OB/GYN, Jivanyog Nursing Home, Visnagar, Gujarat
J. van Roosmalen1, G. Mbaruku2, M. Cotiro3, C. Hoestermann4, D.A.A.            North, India.
Verkuyl5, T. Meguid6 1Leiden University Medical Centre, P.O.Box
9600, 2300 RC The Netherlands 2Kigoma Tanzania, 3Maputo                        Objectives: The aim of the study was to revive the traditional method of
Mozambique, 4Unna Germany, 5Bulawayo Zimbabwe,6Ondangwa                        Uterine Packing for the control of Uterine bleeding (Refractory PPH) at
Namibia                                                                        the time of Cesarean section.
                                                                               Study Methods: A retrospective study from April 1990 to December
The population-based caesarean section rate is one of the indicators of        1999. Total number of Deliveries were 18,925 and Cesarean section
the quality of obstetric care in a community. When home births are             deliveries were 2,503 (13.22%). Out of these 2,503 Cesarean deliveries,
frequent events and often go unnoticed in statistics, this rate is often       11 patients (0.44%) required Uterine Packing for control of Refractory
unknown and falsely replaced by hospital caesarean section rates. WHO          PPH.
states that the population-based CS-rate should be not less than five and      Results: In all 11 patients bleeding was controlled with Uterine Packing
not more than 15%. There is, however, no scientific evidence for this          with minimal morbidity.
statement, and there are good reasons to assume that the rate does not         Conclusions: Uterine Packing in Refractory Postpartum Hemorrhage at
necessarily have to be more than 10%.                                          the time of Cesarean Section is quite a useful conservative life saving
Objective: We propose the use of a new indicator to assess the quality of      technique.
obstetric care in hospital: the ratio of instrumental vaginal deliveries
(IVD) and caesarean section (CS).
Results: This ratio in 1997 was 1.0 (19.806 IVD/19.990 CS) the                 FC1.05 CONTRACEPTION 1
Netherlands and in different hospitals this ranged from 0.5 to 2.2. The
ratio in Westfalia Germany was 0.4 (6.908 IVD/17.723 CS; range 0.1-            FC1.05.01
1.1). In Europe, the lowest ratio was found in Italy: 0.1 (11.650              EFFECTS OF PARITY, AGE, RELIGION AND REGION ON THE
IVD/126.064 CS; range 0.02-0.2). In Tanzania Kigoma the ratio was 0.2          USE OF THE TCU-380A IUD
(144 IVD/602 CS; range 0.0-0.7). Bulawayo in Zimbabwe had a ratio of           R. Rivera, Family Health International, P. O. Box 13950, Research
0.3 (947 IVD/3.007 CS), Onandjokwe in Namibia had a ratio of 0.1 (20           Triangle Park, North Carolina, USA, 27709.
IVD/223 CS) and the lowest ratio was recorded for Maputo
Mozambique: 0.02 (156 IVD/7.211 CS).                                           Objective: The objective of the study was to establish whether the parity,
Conclusions: One of the reasons for the extraordinary high rate of CS          age, religion of women and site of insertion had any effect on the early
(e.g. in Italy) is the infrequent use of instrumental vaginal deliveries. In   discontinuation of TCu-380A.
such circumstances many newborns will be born by CS who could easily           Study Methods: A total of 2,478 women who had a TCu-380A inserted
have been born by instrumental vaginal delivery with much less                 in 14 countries were studied. First year reasons for discontinuation were
maternal morbidity and even mortality. Another reason for a low ratio          calculated by single-decrement gross cumulative life-tables, stratified by
may be the lack of adequate monitoring during labour, which is more            each of the client characteristics. Log-rank tests were used to compare
easily solved with CS than awaiting first and second stages of labour          the reasons for discontinuation among the different groups of women’s
before proceeding with IVD. In both situations the conclusion could be         characteristics.
that the overuse of CS may lead to an increase in maternal mortality and       Results : Discontinuation rate, for all reasons combined, at one year was
serious morbidity, even more so in the case of HIV-positive women.             13.3%, mainly due to bleeding and pain (4.5%) and expulsion (3.1%).
Calculating the ratio in different institutions will help with the analysis    Parity did not affect any of the reasons for discontinuation. Women less
of obstetric practice and may lead to a reduction of unnecessary major         than 20 years old had significantly higher expulsion rates than older
surgery.                                                                       women. Religion had a significant effect on all reasons for
                                                                               discontinuation, particularly for bleeding and pain. Muslim women had
                                                                               significantly higher removal rates due to bleeding and pain than
FC1.04.08                                                                      Protestant women. The site of insertion also had a significant effect on
SHOE SIZE AND PELVIC ADEQUACY                                                  discontinuation for all reasons, particularly on expulsion rates. Sites in
L.J. van Bogaert, Dept. OB/GYN, MEDUNSA Philadelphia Hospital,                 Africa had significantly higher expulsion rates than sites in Asia.
Dennilton, South Africa.                                                       Conclusions : Our results showed that Muslim women had higher
                                                                               removal rates due to bleeding and pain than women of other religions.
Objectives: The aim of the study was to investigate the effect of shoe         Counseling on bleeding and pain problems should be carefully addressed
size on the mode of delivery: cesarean birth (CB) or spontaneous vaginal       with Muslim women. A higher risk of expulsion among women less than
delivery (SVD).                                                                20 years old also needs to be addressed when counseling.
Study Methods: Three hundred eighty-eight women were included in
this retrospective study: 75 had a CB (19.3%) and 313 a SVD (80.7%).
Groups were compared by unpaired t-test; simple linear analysis was            FC1.05.02
used to investigate the correlation between variables.                         A COMPARATIVE ASSESSMENT OF THE EZ·ON® PLASTIC
Results: Shoe size were similar: 5.7 (5.6 to 5.8) with SVD and 5.5 (5.2        CONDOM AND A LATEX CONDOM
to 5.8) with CB. All of the other parameters (age, parity, end-pregnancy       L.Cook, K.Nanda, D.Taylor, Family Health International, P.O. Box
weight, height and birth weights) were similar. Height was known in 24         13950, Research Triangle Park, NC, United States, 27709.
of the CB (32.0%) and in 86 of the SVD (27.5%). Shoe size correlated
with height in patient with CB (r=0.53; p=0.008) but not in patients with      Background: Latex condoms are both an important contraceptive
SVD (r=0.19; p=0.075). There was no significant correlation between            method and an effective strategy for the prevention of sexually
birth weight and maternal variables in patients with a CB. There was a         transmitted infections (STIs). However, latex condoms can cause
statistically significant correlation between birth weight and maternal        allergic reactions and have short shelf-life, particularly in extreme
weight (r=0.29; p<0.001), parity (r=0.23; p=0.0001). age (r=0.016) and         climates. As a response, condoms made from alternative material have
shoe size (r=0.28; p<0.0001) but not with height (r=0.04; p=0.72) in           been developed. The eZ·on® condom, recently developed by Family
women with SVD.                                                                Health International and Mayer Labs, Inc., is made from polyurethane
Conclusion: Since shoe size is similar in women with comparable                film and has a baggy, non-constricting design which can be donned by a
anthropometric features having a CB or a SVD, it is not a useful               unique bi-directional pull-on motion.
indicator of pelvic (in-) adequacy.                                            Objective: This randomized controlled cross-over trial compared the
                                                                               breakage and slippage rates, safety, and acceptability of the eZ·on®
                                                                               condom with a marketed latex condom.
                                                                               Methods: A total of 360 mutually-monogamous, sexually-active,
                                                                               heterosexual couples at low risk of sexually transmitted infections were
                                                                               recruited. We randomized couples to one of two condom use sequences
22                                                                                                                       MONDAY, SEPTEMBER 4

(four eZ·on® condoms used during four consecutive acts of vaginal             FC1.05.04
intercourse followed by four latex condoms, or the reverse sequence).         DAILY LOW DOSE MIFEPRISTONE HAS CONTRACEPTIVE
Participants recorded instances of breakage and slippage of the study         POTENTIAL BY SUPPRESSING OVULATION AND
condoms. We tested the null hypotheses that the clinical breakage or          MENSTRUATION: A STUDY OVER 4 MONTHS IN EDINBURGH
complete slippage proportions for the eZ·on condom exceeded those of          AND SHANGHAI
an existing latex condom by 2%. We used generalized estimating                A. Brown (1), A. Mayo (1), K.B. Smith (1), L. Cheng (2), S. Lin (2),
equation methods to adjust for within-couple correlation among condom         D.T. Baird (1) Contraceptive Development Network, Center for
uses. Rejection of the null hypothesis for a specific breakage or slippage    Reproductive Biology, University of Edinburgh, UK. Shanghai Institute
comparison was considered statistical evidence of non-inferiority             of Family Planning Technical Instruction, Shanghai, PR China.
Results: The clinical breakage rate for the eZ·on® condom was 5.6%,           Objectives: The aim of this study was to determine the effect of daily
compared with 0.9% for the latex condom (difference = 4.76%, with             low dose mifepristone, given over 120 days on the ovarian cycle and on
upper 95% confidence bound on the difference = 6.26%), thus we failed         the pattern of menstrual bleeding.
to conclude equivalence relative to clinical breakage. The complete           Study Methods: This was a double-blind parallel group study in
slippage rate for the eZ·on® condom was 1.6%; compared to 0.7% for            Edinburgh and Shanghai in healthy female volunteers, aged between 18
the latex condom (difference = 0.97%, with upper 95% confidence               and 40 years, 98 women (58 in Edinburgh and 40 in Shanghai) were
bound = 1.55%), thus we were able to rule out a difference of 2%, and         randomized to receive either 2mg or 5mg of mifepristone daily for 120
conclude equivalence between the two condom types relative to                 days. Ovarian activity was monitored by the measurement of the
complete slippage. Few adverse events occurred with either condom,            oestrone-1-glucuronide/creatinine (E1G/C) and pregnanediol/creatinine
and no difference was seen in the probability of experiencing an adverse      (P/C) ratios in weekly samples of early morning urine, and by monthly
event between condoms. Although there was no clear preference for             plasma oestradiol (E2) levels. Subjects kept a daily diary of menstrual
either condom, 29% of female partners and 28.8% of male partners              bleeding throughout the study.
strongly preferred eZ·on® as compared to the latex condom.                    Results: 90 women (50 in Edinburgh and 40 in Shanghai) completed the
Conclusion: Like several other non-latex products tested to date, the         study. 8 women withdrew for a variety of reasons: gastric upset (2),
eZ·on® condom has a higher clinical breakage rate than its latex              irregular bleeding (1), hypertension (1), and personal reasons (4). The
comparator. However, clinical breakage and slippage rates alone do not        Edinburgh group showed biochemical evidence of ovulation in 15 of the
necessarily reflect contraceptive effectiveness or STI prevention (e.g.,      200 months of treatment (10 ovulatory episodes in the 2mg group and 5
non-use is an important factor). We await the results of an ongoing           in the 5mg group). The Shanghai group showed evidence of ovulation in
contraceptive effectiveness study of the eZ·on® condom. Latex condoms         3 of the 160 months of treatment (2 in the 2mg group and 1 in the 5mg
continue to be reliable in terms of breakage and slippage; the eZ·on®         group). Measurement of E1G/C and E2 showed evidence of continued
condom may be an acceptable alternative for couples unable or                 ovarian follicular activity, similar to that seen in the follicular phase of
unwilling to use latex condoms.                                               the normal cycle. In Edinburgh, 65% of the 2mg group were
                                                                              amenorrhoeic throughout the 120 days of treatment, as were 88% of the
                                                                              5mg group. In Shanghai, 90% of women in both treatment groups were
FC1.05.03                                                                     amenorrhoeic. Those women who did bleed reported a reduction in the
FAMILIAL PLANNING AT UNIVERSITY HOSPITAL OF                                   amount of bleeding compared to the normal menstrual period. There
BRASILIA                                                                      were no pregnancies reported in the 200 months of exposure in 50
M.S. Wanderley, C.A.R. Silva, A.G. Chaves, A.C.R. Cunha, C.N.                 women (10 in Edinburgh and 40 in Shanghai) who used no other method
Resende, C.R.R. Miranda, Dept. OB/GYN, Faculty of Medicine,                   of contraception during the study.
University of Brasilia, Brazil.                                               Conclusions: A daily dose of mifepristone of 2 or 5mg suppresses
                                                                              ovulation and menstrual bleeding and offers promise as a novel estrogen
Objective: To evaluate the most common contraceptive methods used by          free method of contraception. Supported by a grant from MRC/DFID
our patients: IUD (intra-uterine device) and OC (oral contraceptives).        (grant no: G952350).
Study Methods: We analyzed prospectively 367 outpatients who visited
the familial planning service of the University Hospital of Brasilia
(HUB) over the past three years. We evaluated the side effects, the           FC1.05.05
prevalence of genital infection and the performance of the methods used.      TUBAL INFERTILITY AND COPPER IUD USE AMONG
Results: The median age was 27 years old (range: 14-52). Of these 367         NULLIGRAVID WOMEN
patients, 228 (62.1%) were using IUD, 70 (19.1%) OC, 42 (11.4%)               D. Hubacher, Family Health International, Research Triangle Park, NC,
condom, and 27 (7.4%) other methods. The side effects most frequently         USA; R. Lara, National Perinatology Institute, Mexico City, Mexico;
observed for IUD and OC users were dysmenorrhoea (32% and 4.3%                D. Taylor, Family Health International, Research Triangle Park, NC,
respectively), menstrual irregularities (16.7% and 17.1%), vaginal            USA.
discharge (9.6% and 2.8%), spotting (3.1% and 7.1%) and psychological
symptoms (0.4% and 14.3%). When we compared both methods, we                  Objectives: The aim of this study was to re-investigate the possible link
observed dysmenorrhoea was significantly more frequent in IUD users           between copper IUD use and subsequent tubal infertility among
(p<0.05, X2) and psychological problems such as depression and anxiety        nulligravid women.
in OC users (p>0.05, X2). Bacterial vaginosis was the most common             Study Methods: Thus far, 1,943 women were recruited for this
genital infection, observed in 46 (20.2%) IUD users and in 14 (20%) OC        unmatched case-control study (95% of the projected final study size).
users, followed by moniliasis (39 (17.9%) and 10 (11%) respectively),         For this preliminary analysis, 846 incident cases of primary tubal
trichomoniasis (21 (9.2%) and 6 (8.6%) respectively) and HPV (10              infertility were compared to two different control groups: 488 incident
(4.4%) and 3 (4.3%) respectively). There was no statistical difference        primary infertile women without tubal pathology and 609 primigravid
(p=0.06, X2) when we compared the prevalence of genital infection in          women in their 1st or 2nd trimester. Hysterosalpingogram and/or
both groups of patients. Five patients (1 IUD user and 4 OC users)            laparoscopy findings were used to distinguish the two types of infertile
became pregnant and 90.2% of the patients were satisfied with the             women. Retrospective data on previous contraceptive use, sexual
chosen contraceptive method.                                                  relations, history of STDs, and standard sociodemographic
Conclusions: IUD was the most common method used. Most of the                 characteristics were collected on all women. In addition, participants
patients were satisfied with their chosen method, in spite of side effects.   donated a sample of blood to check for presence of Chlamydial
And IUD did not seem to affect the prevalence of genital infections.          antibodies.
                                                                              Results: Separate analyses were conducted to compare each control
                                                                              group with cases. The multivariable logistic regression indicated that
                                                                              previous copper IUD use was not an independent risk factor for tubal
                                                                              infertility; the adjusted odds ratios and 95% confidence intervals were
                                                                              1.3 (0.75-2.1) and 1.2 (0.76-1.9), controlling for numerous factors
                                                                              simultaneously. Presence of Chlamydial antibodies, however, was
                                                                              associated with an increase in the risk of tubal infertility.
MONDAY, SEPTEMBER 4                                                                                                                                 23

Conclusions: Though the study is not complete, the results of this         significantly improving tolerability. Monophasic, biphasic, triphasic and
preliminary analysis suggest that nulligravid women are appropriate        progestogen-only preparations are available, and the choice of
candidates for IUDs. Since copper IUDs alone do not protect women          formulation should be tailored to best suit the patient. There is a need to
from the dangers of STDs, barrier methods should be used                   balance the provision of safe and effective contraception against the
concomitantly by women who desire an IUD, yet who are not in               desire to avoid interventions that might unnecessarily restrict the
mutually monogamous relationships.                                         availability of combined oral contraceptives. Current scientific evidence
                                                                           suggests only two pre-requisites for the safe provision of oral
                                                                           contraceptives: a careful personal and family medical history with
FC1.05.06                                                                  particular attention to cardiovascular risk factors, and an accurate blood
MECHANISMS OF ACTION OF LEVONORGESTREL (LNG) AS                            pressure measurement. Further assessment is required only if a relevant
EMERGENCY CONTRACEPTIVE (EC).                                              personal or family history is disclosed or the blood pressure is elevated.
M. Durand, O. Durán, M.C. Cravioto, F. Larrea, Instituto Nacional de la    Only a small minority of women will require this further assessment.
Nutrición, Vasco de Quiroga 15, Mexico City, D.F., Mexico, 14000.          Any areas of uncertainty or concern that the patient has should be
                                                                           addressed, and the patient should be clearly informed of how to use the
Objectives : To understand the mechanisms by which LNG (two doses          oral contraceptive effectively, the likely initial adverse
of 0.75 mg, taken 12 h apart each) prevents pregnancy when given as
follows: A) on day 10 of the cycle, B) immediately after urine LH surge,
and C) 24 h after follicle rupture (FR).                                   FC1.05.09
Study Methods : Forty five sterilized women, randomly assigned to          CONTRACEPTIVE COUNSELLING; A MATTER OF ATTITUDES
treatment groups A, B and C, were studied during one control and one       Rik H.W. van Lunsen, Dept. of Sexuology & Psychosomatic Ob/Gyn,
treated cycle. Blood samples were withdrawn everyday to measure            Division of Ob/Gyn, Academic Medical Centre, University of
estradiol (E2) and progesterone (P4) since the urine LH surge until        Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
menses. Transvaginal ultrasound was performed daily since the urine
LH surge until FR and endometrial biopsy on day LH+9.                      The role of the physician-gynaecologist or general practitioner in
Results : The administration of LNG significantly (p<0.005) shortened      providing contraceptive services is that of a counsellor who listens and
the mean length of the cycle in Group A. In 5 subjects of this group       talks instead of that of a doctor who acts.
urine LH surge and FR were prevented, although follicle development        Already in 1968 a Dutch survey amongst unprotected sexually active
was observed in 3 of them. Only 3 out of the 10 remaining subjects         teenagers revealed that there were several reasons for not seeking
presented P4 serum concentrations >3 ng/ml following FR. The               contraceptive advice. Two of the main reasons were related to fear for
administration of LNG to women in Groups B and C did not modify            the doctor: fear for pelvic examination and fear for a lack of
ovulatory markers or serum concentrations of steroid hormones.             confidentiality. In the Netherlands these fears no longer play important
Conclusions : LNG as an EC inhibits ovulation and/or corpus luteum         roles because contraceptive consultations are demedicalised as much as
function only when given preovulatory. Contraceptive efficacy of peri-     possible. At the first visit motives for the request are discussed,
and post-ovulatory LNG administration might be at the endometrial          questions are answered and information is provided, but except for a
level preventing implantation. (Supported by FHI).                         screening medical history all medical procedures are abandonned. No
                                                                           pelvic examination is performed, no laboratory tests are conducted and
                                                                           blood pressure is only measured when indicated. Another change has
FC1.05.07                                                                  been that GP’s and gynaecologists confronted with a young girl wishing
TO WHICH EXTENT IS IT POSSIBLE TO HAVE EMERGENCY                           a contraceptive method, will not try to argue her request. When she asks
CONTRACEPTION AVAILABLE WITHOUT MEDICAL                                    for contraception, she will need it and must get it whatever the doctors
PRESCRIPTION?                                                              thoughts and feelings might be. A typical misconception that prevents
E.Aubeny, French Association for Contraception, Paris, France., Aubeny     contraceptive counselling from being effective is the idea that the aim of
Elisabeth, rue du Docteur Lancereaux 10, Paris 75008, France               contraception is to prevent pregnancy. If that were the only
                                                                           consideration, abstinence would be a solution. Only awareness of the
In France, two dedicated products are available for Emergency              fact that the primary objective of contraception is to be able to be
Contraception (EC). One is a combined ethynilestradiol - levonorgestrel    heterosexually active without fear for unwanted pregnancy, will enable
product (Tetragynon®). The other one is a levonorgestrel-only product      the doctor to refrain from “prescribing” a method and to enable the
(Norlevo®). As shown by previous studies, efficacy of these products is    individual woman to choose a method that will meet her personal wishes
higher when they are taken earlier after an unprotected intercourse.       and expectations. In ongoing studies on the dynamics of contraceptive
Therefore, the need to undergo a medical visit prior to their              use in the Netherlands we found that effective contraceptive behaviour is
administration clearly diminishes their efficacy. Combined                 mainly related to aspects of female autonomy. The more women make
ethynilestradiol - levonorgestrel product has only one contraindication:   their own decisions and the more they are able to communicate with
previous thrombo-embolic accidents. An interrogation carried out by        their partner about wishes, expectations and boundaries, the more
para-medical staff is sufficient to detect these previous disorders. Its   effectively they will protect themselves. This is one of the explanations
seems therefore possible that para-medical staff deliver this drug on      for the fact that pill-failure rates in the Netherlands (pregnancy rate ±
medical supervision. But consulting para-medical staff will also delay     0.4) are at least five times lower than in the UK and VS.
the use of EC. Levonorgestrel administration has no contraindication,
the French Health authorities have therefore allowed the pharmacists to
deliver the levonorgestrel-only product without medical prescription.      FC1.06 ENDOMETRIAL ABLATION
The product can also be directly delivered for free by high - school
nurses to pupils in case, for any reason, they cannot obtain the product   FC1.06.01
from a pharmacy or have no possibility to get a fast appointment in a      HYSTEROSCOPY IN DYSFUNCTIONAL UTERINE BLEEDING
Family Planning center. These provisions should facilitate early use of    V. Gheorman, Dept. OB/GYN, Medical University of Craiova, Craiova,
EC and contribute to the decrease of unwanted pregnancies, specially       Romania.
teen-ager ones.
                                                                           The author presents his experience in using the hysteroscopy method for
                                                                           the positive and differential diagnosis of dysfunctional uterine bleeding
FC1.05.08                                                                  (DUB). He considers a series of 83 patients with DUB to whom he
PRESCRIBING ORAL CONTRACEPTIVES                                            practiced the hysteroscopy. He estimates that the hysteroscopy can
Carmen Coll Capdevila, MD. President of the European Society of            diagnose a DUB excluding an organic disease, which could generate the
Contraception. Director of the Women's Health Programme of Maresme.        bleeding.
Catalan Institute of Health. Consell de Cent, 170, 3A; 08015-Barcelona;    At the same time, by using hysteroscopy, a special biopsy followed by a
Spain.                                                                     histological analysis may be done. The author describes congested
                                                                           lesions in DUB which resemble ‘leopard fur’ or ‘shah table’.
The combined oral contraceptive pill is the most popular method of         Endometrectomy by hysteroscopy became a diagnosis method and a
contraception worldwide, with modern low-dose formulations                 limited treatment method. The treatment in DUB is theoretically a
24                                                                                                                      MONDAY, SEPTEMBER 4

medical one (using drugs). The cases which require surgical treatment         endometrial uptake of the photosensitiser 5-aminolaevulinic acid (ALA)
are the result of the failure of treatment with drugs.                        and whether this would result in greater PDT effects when the laser was
                                                                              applied and whether these effects were long lasting.
                                                                              Study Methods: ALA was dissolved in phosphate buffered saline (pH
FC1.06.02                                                                     4.5-5) with or without CP94. At laparotomy, 0.5ml of the ALA solution
OFFICE HYSTEROSCOPY                                                           was injected into one uterine horn and 0.5ml of the combined ALA-
Hakan R. Yalçın, Hüseyin Yesilyurt, Selçuk Arslan, Turgut Var, Perran         CP94 solution was injected into the other horn, of 24 normal female
Moröy, Havva Oral, Oya Gökmen. Zekai Tahir Burak Women’s Health               rabbits. Our initial experimentation determined that the time for peak
Education and Research Hospital, Infertility Clinic, Ankara-Turkey            absorption was seven hours. At this time, the uterine horns were
                                                                              illuminated with a 4cm cylinder diffuser fibre using red light (628nm,
Diagnostic, panoramic hysteroscopy can be performed in an office              100mW per cm of fibre) from a diode laser (total energy 400J per horn).
setting with small discomfort to the patient. The indications,                The uterine horns were removed at three, ten and 28 days after PDT, and
contrindications and technique of office hypsteroscopy do not differ          underwent histological examination.
significantly form those of hysteroscopy. The procedure enables the           Results: There were no complications. PDT resulted in incomplete
physician to search for organic intrauterine abnormalities and to select      destruction of the endometrium with ALA alone, but was complete with
the proper form of theraphy based on the observations. Often no               the combination. There was minimal regeneration seen at 10 and 28
pathology is seen and further surgical intervations are not needed.Our        days, with the combination, but regeneration appeared complete with the
purpose was to evaluate, a total of 157 patients who underwent office         ALA alone. There was no myometrial damage.
hysteroscopy between March 1998 and December 1999 at Zekai Tahir              Conclusion: ALA used in combination with CP94 is an effective
Burak Women’s Health Education and Research Hospital Infertility              photosensitiser. PDT damage in the rabbit endometrium from the
Clinic, Ankara, TURKEY.The procedure without anesthesia was well              combination is total and long lasting. We are now in a position to use
tolerated by the majority of the women. As a conclusion office                this in human studies.
hysteroscopy has a high success rate and a low complication rate. We
believe that it is a safe well tolerated and cost effective procedure of
great diagnostic value.                                                       FC1.06.05
                                                                              TREATMENT OF CHRONIC PELVIC PAIN WITH
                                                                              LAPAROSCOPIC DISSECTION OF THE UTEROSACRAL
FC1.06.03                                                                     LIGAMENTS
DOUBLE BLIND, RANDOMISED CONTROLLED TRIAL                                     Yesilyurt H, Yalçın H, Var T, Moröy P,Yılmaz Z, Oral H, Gökmen O
COMPARING THE ND:YAG LASER ENDOMETRIAL ABLATION                               Zekai Tahir Burak Women’s Health,Education and Research Hospıtal
TO THE CAVATERM™ THERMAL BALLOON FOR THE                                      Ankara, Turkey
JA Abbott, JA Hawe, G Phillips, R Garry WEL Foundation South                  As an increasing number of women without pathological findings suffer
Cleveland Hospital Marton Road, Middlesbrough TS4 3BW England                 from chronic pelvic pain it has become necessary to use simple
                                                                              treatments involving relatively few complications. From January 1996-
Objective: To evaluate the clinical results and quality of life outcomes      to January1998, 144 patients with choric pelvic pain performed
after endometrial ablation using the Cavaterm thermal balloon compared        laparoscopy at our department. The most frequent finding were
to the Nd-YAG laser .                                                         endometriosis (33%), pelvic adhesions (24%) -, Allen-Masters syndrome
Study Methods: Seventy two patients with menorrhagia were included in         4% and pelvic congestion 2%, In 15% of the patients with choric pelvic
this double blind randomised trial. Only patients with a normal uterine       pain, diagnostic laparoscopy did not find pathology ın the pelvis. This
cavity, determined by hysteroscopy, normal endometrial biopsy and             latter group of patients were treated by means of dissection of the
cervical cytology were included.                                              uterosacral ligaments performed at the same time as the diagnostic
Results: Amenorrhea rates are currently 37% for the ND:YAG laser              laparoscopy. None of them had experienced a sustained response to
group and 39% for the Cavaterm thermal ablation system. 12-36 month           treatment with analgesics and psychological intervention. At 3 months
follow up data will be presented. Overall satisfaction for both procedures    after the operation 50% of the patients who presented for follow up were
is high (89% Nd:YAG laser and 96% Cavaterm). There is considerable            completely free of symptoms, with an additional 37.5% showing a
improvement in all aspects of quality of life in both patient groups as       significant alleviation of pain. There was little change in these
measured by SF 12, EUROQOL and sexual activity questionnaire’s.               percentages 12 months after treatment. No surgical complications were
General health scores improve back to normal levels in both groups.           observed. We conclude that this procedure represents a promising
There appears to be a greater reduction I dyspareunia in the cavaterm         alternative treatment for patients with chronic pelvic pain.
group. In addition, the number of menstrual days, dysmenorrhea and
PMS scores are all significantly reduced in both groups
Conclusion: Whilst long term follow up data is not yet available, short       FC1.06.06
term structured evaluation suggests that Cavaterm™ achieves acceptable        ENDOMETRIAL LASER INTRAUTERINE THERMO-THERAPY, A
amenorrhoea rates and significant improvement in patients quality of          NEW TECHNIQUE FOR THE TREATMENT OF DYSFUNCTIONAL
life. There does not appear to be any significant differences in outcomes     UTERINE BLEEDING
in the Cavaterm versus Nd:YAG laser group.                                    K.D. Jones, C.J.G. Sutton, Minimal Access Therapy Training Unit, The
                                                                              Royal Surrey County Hospital, Guildford, UK.

FC1.06.04                                                                     Objectives: To present the results of endometrial ablation using the
DOES PDT HAVE A PLACE IN THE TREATMENT OF                                     Endometrial Laser Intrauterine Thermo-Therapy (ELITT) system.
MENORRHAGIA?                                                                  Introduction: The ablation is performed using a compact, tabletop, 20 W
Rowan J Connell, National Medical Laser Centre & Department of                Diode laser, and a disposable handset. The laser is activated for 7
Obstetrics and Gynaecology, University College London, UK                     minutes to heat and coagulate the endometrium.
Alison Curnow, National Medical Laser Centre, Department of Surgery,          Patients: 25 women between the ages of 30-52 years, with documented
University College London, UK. Alfred Cutner, Department of                   menorrhagia, who had no uterine organic lesions.
Obstetrics and Gynaecology, University College London, UK                     Study Methods: A pictorial blood loss assessment chart (PBAC) was
Stephen G Bown, National Medical Laser Centre, Department of                  used to quantify menstrual blood loss. Women with a score > 150 were
Surgery, University College London, UK                                        prospectively recruited, and had the procedure performed under general
Objectives: Photodynamic therapy (PDT) has considerable potential as a        Results: The mean age of patients was 41.6 years (32 – 52). At 3 months
minimally invasive option for treating menorrhagia by ablating the            the average PBAC score fell from a pre-operative value of 452 (169 –
endometrium. It is a non-thermal technique for producing tissue               1115) to a post-operative value of 64 (0 – 477). The average score
necrosis, involving the interaction of light with a photosensitiser, in the   reduction was 86%, and the amenorrhea rate was 56% (76% including
presence of tissue oxygen. The aims of this study were to determine           hypomenorrhea, PBAC < 30). The average pain score fell from a pre-
whether the addition of the iron-chelating agent CP94 would enhance           operative value of 36 (0 – 70) to a post-operative value of 6 (0 – 40). To
MONDAY, SEPTEMBER 4                                                                                                                                   25

date, 2 women (8%) have undergone a hysterectomy and one has been            Study Methods: Reactivity and beat-to-beat variability were analyzed in
commenced on a course of GnRH analogue for concurrent                        29,672 patients. NST was defined as reactive or non-reactive,
endometriosis, and 13 women have been followed up for 6 months.              variability-normal or decreased. All tests were performed within 7 days
Conclusion: Women who have had an ELITT procedure company very               of delivery. Neonatal outcome was judged as normal or adverse.
favorable with women who have had an endometrial ablation with               Results: Statistical parameters and relationship between NST, variability
electrosurgical equipment or Nd: YAG surgical laser.                         and neonatal outcome are reflected in the tables below:
                                                                             Neonatal Outcome            Reactive                        Non-Reactive
FC1.06.07                                                                    Normal                      27,612 (99%)                    1,669 (94%)
THE NOVASURE SYSTEM FOR ENDOMETRIAL ABLATION                                 Adverse                     280 (1%)                        111 ( 6%)
J. M. Cooper, University of Arizona, Phoenix, AZ, United States
The NovaSure System consists of a single use, 3-Dimentional bipolar          Neonatal Outcome            Normal                          Decreased
device and RF Generator that enable a customized, controlled and             Normal                      29,046 (99.8%)                  427 (76.5%)
contoured endometrial ablation in an average of 90 seconds treatment         Adverse                     68 ( 0.2%)                      131 (23%)
time without the need for concomitant hysteroscopic visualization and/or     (P<0.01)
endometrial pre-treatment.                                                   Specificity                 Sensitivity      PPV            NPV
The NovaSure Endometrial Ablation Device uses bipolar electrodes             NST                         28.4%            98.9%          6.2%
distributed over a fan-shaped array to ablate the endometrium. Steam         94.3%                                         Variability 65.8% 23.5%
and moisture, liberated from the desiccated tissue, are evacuated by                                     99.8%         98.6%
continuous suctioning. As desiccation reaches the predetermined and          PPV – Positive predictive value                                NPV –
optimal depth, the increasing impedance causes the generator to              Negative predictive value                           Conclusion
terminate power delivery, thereby providing a self-regulating ablation       Poor variability is a better predicator of adverse neonatal outcome than
process.                                                                     non-reactive NST.
Preliminary results from an initial group of 100 patients treated at 6
investigational sites demonstrate extremely high success and amenorrhea
rates, with an average treatment time of 90 seconds (ranging from 40 to      FC1.07.02
120 sec.).                                                                   A RANDOMISED CONTROLLED TRIAL USING SERIAL
                                                                             DIRECTED REAL TIME ULTRASOUND TO IDENTIFY THE AT-
                                                                             RISK FETUS IN A LOW RISK POPULATION
FC1.06.08                                                                    D. McKenna, S. Tharmaratnam, A. Harper, J. Dornan Dept. OB/GYN,
ENDOMETRIAL ABLATION INDUCES ALTERATIONS IN                                  Royal Maternity Hospital, Belfast, United Kingdom.
PROSPECTIVE LONGITUDINAL STUDY IN A DISTRICT                                 Objectives: The aim of the study was to evaluate the effect of
GENERAL HOSPITAL                                                             introducing two-minute real-time ultrasound examinations in a low-risk
Mohammed K1, Okolo S2. Departments of 1Radiology and 2Obstetrics &           population. These were performed during routine visits at 30-32 weeks
Gynaecology, North Middlesex Hospital, London UK                             gestation and 36-37 weeks gestation. Scans assessed Placental Maturity
                                                                             (P), Amniotic Fluid Volume (A) and Estimated Fetal Weight(W).
Introduction: Endometrial ablation is now established as a first line        Primary outcome measures were rates of intervention during study
treatment for menorrhagia. Reduced endometrial thickness and intra-          period (eg fetal assessment scan, hospital admission etc), frequency of
uterine synechiae contribute to the reduction in menstrual loss but little   small for dates (<10th centile at birth) and admission to neonatal
is known of the associated changes, if any, in uterine artery blood flow     intensive care.
which is ultimately responsible for endometrial perfusion.                   Study Methods: One thousand nine hundred and ninety eight patients
Subjects & Methods: We therefore monitored uterine artery pulsed             were randomised at 30 weeks gestation to a control group receiving
Doppler blood flow before and after endometrial resection with loop          standard antenatal care, or to the study group who also received a PAW
diathermy in 11 non-obese (body mass index < 28 kg/m2) women aged            PAW scan.
42.2 + 1.25 years (mean + sem) who had gonadorelin (Zoladex, Zeneca          Results: The rates of intervention in the study and control groups were
UK) down-regulation four weeks before surgery. Assessments were              16.6% (166/999) and 20.9% (209/999), respectively (P=0.016). The
made before down-regulation, immediately pre-operatively, and at 1, 6,       proportion of infants assessed as small for dates at birth in the study
12 and 24 weeks post-operatively.                                            group was 6.9% (69/994) compared with 10.4% (104/999) in the control
Results: 10 women (90.9 %) experienced satisfactory reduction in their       group (p=0.008). Twenty eight (2.8%) of neonates in the study group
menstrual loss at 24 weeks but one woman requested a hysterectomy for        were admitted to the neonatal unit compared with 34 (3.4%) in the
continuing menorrhagia. Mean uterine volume was unchanged.                   control group (p=0.53).
Endometrial thickness decreased from 6.0 + 0.47 mm (mean + sem)              Conclusions: Introduction of a PAW PAW scan at 30-32 weeks and 36-
before down-regulation to 3.2 + 0.43 mm at 24 weeks whilst pulsatility       37 weeks gestation reduced the intervention rate and the risk of a low
index increased by 36 % from 2.245 + 0.156 to 3.051 + 0.025 in the left      birthweight baby. Rates of admission to a neonatal unit were not
uterine artery (p = 0.004) and by 30 % in the right artery from 2.386 +      affected. Possible reasons for these results will be discussed.
0.227 to 3.098 + 0.114 (p = 0.034). In the patient with continuing
menorrhagia, the increase in mean pulsatility index was much less at 14
% and 19 % for the left and right arteries respectively.                     FC1.07.03
Conclusion: Endometrial ablation is associated with reduced uterine          ROUTINE ULTRASOUND SCREENING -UNCOVERING A RISK
artery blood flow, and Doppler blood flow measurements may predict           GROUP FOR HIGHER PERINATAL MORTALITY, PREMATURE
women whose ablation will fail.                                              BIRTH AND LOW PONDERAL INDEX
                                                                             J.Nakling, Dept.OB/GYN, Central Hospital of Oppland, Lillehammer,
                                                                             Norway. B.Backe, Dept.OB/GYN, University Hospital of Trondheim,
FC1.07 FETAL ASSESSMENT                                                      Norway
FC1.07.01                                                                    Objectives: The aim of the study was to evaluate the possibility of an
DOES NST OUTLIVE ITS USEFULNESS?                                             increased risk of impaired
B. Petrikovsky (1) (2), E. Schneider (2), M. Ostrovsky (2)                   fetal growth and adverse fetal outcome when the predicted day of
(1) Nassau County Medical Center, Dept. OB.GYN, East Meadow, NY,             delivery according to ultrasound method was postponed more than 14
USA.                                                                         days compared to estimated date of delivery according to the last
(2) North Shore University Hospital, Manhasset, NY, USA.                     menstrual period.
                                                                             Study Methods: Included in the study where singleton deliveries
Objective: To compare the usefulness of reactivity and variability in        (n=16210) where the pregnant woman had underwent a routine
non-stress testing.
26                                                                                                                       MONDAY, SEPTEMBER 4

ultrasound screening and the biparietal diameter of the foetus had been       made to diagnose this condition prenatally to avoid fetal mortality from
measured between 35mm and 60mm and the mother had a reliable date             this cause.
about her last menstrual period. The study group had postponed
estimated date of delivery more than 14 days compared to estimated date
of delivery according to the last menstrual period. In the control group      FC1.07.06
the difference between the estimated date of delivery between the two         THE EFFECTS OF TRANSDERMAL NITROGLYCERIN (NITROL
methods where less than 15 days.                                              PATCH) ON THE UTERINE AND UMBILICAL ARTERY BLOOD
Results There was a higher perinatal mortality (p<0,0002 95%CI                FLOW IN PREECLAMPSIA: A RANDOMIZED DOUBLE BLIND
1,47<OR<4,28), prematur birth (p<0,000002 95% CI 1,35<OR<2,16)                PLACEBO CONTROLLED STUDY
and a higher proportion of low Ponderal index (p<0,04 95%CI                   M.B. Decano, Dept. OB/GYN, Philippine General Hospital, Manila, Phil
1,00<OR<2,00) in the study group compared to the control group.               L.T. Cabrera, Dept. OB/GYN, Philippine General Hospital, Manila,
Conclusions: 6,8% of the population (study group) are including 17% of        Phil.
the perinatal deaths, 11% of the premature births and 29% of the
foetuses with a Ponderal index lower than 2,32 (5 percentil). With a          Objective: To determine the effects of transdermal nitroglycerin in the
routine ultrasound screening there is a possibility of identifying a risk     uterine and umbilical artery blood flow as measured by doppler
group for adverse outcome of pregnancy if the doctor take into account        umbilical systolic diastolic (SD) ratio, pulsatility index (PI), resistance
both the women menstrual history and the biometry of the ultrasound           index (RI) and uterineSD and PI.
screening.                                                                    Materials and Methods: Of the sixteen preeclamptics included in the
                                                                              study, nine were randomly assigned to the nitrol patch group and seven
                                                                              to the placebo group. The nitrol patch group were treated with nitrol
FC1.07.04                                                                     patch 5 mg covered with gauze for 16 hours for three consecutive days.
PONDERAL INDEX, INTRA-UTERINE GROWTH RESTRICTION                              The placebo group were treated to same regimen using gauze only. The
AND LIVER/BRAIN RATIO                                                         uterine SD and PI and umbilical SD, PI and RI were assessed by doppler
D.R. Abramovich (1), A. Bendomir (1), E. Gray (2), P. Haggarty (3)            ultrasound before the treatment and daily for five consecutive days by
Dept. OB/GYN, University of Aberdeen, Scotland, Pathology,                    one investigator who was blinded. The participants were blinded.
University of Aberdeen, Foresterhill, Scotland. Rowett Institute              Results: The mean differences in umbilical PI, umbilical RI and uterine
Aberdeen, Scotland                                                            PI between the nitrol patch and placebo groups were statistically
                                                                              significant in days one to three in the >28-32 weeks age of gestation.
Ponderal Index (PI – weight [gm]/length 3[cm]x100) is used as an index        The mean differences in umbilical SD and PI, uterine SD and PI were
of intrauterine growth restriction (IUGR). Severe IUGR is reflected by        significantly different between nitrol patch and placebo group in the >
an abnormal liver/brain weights.                                              32-36 weeks age of gestation. The mean differences of umbilical PI,
Study Methods: Data from 276 cases of still-birth (24-36 wks) from            uterine SD and PI were significantly different during and after treatment
Aberdeen Maternity Hospital (1986-96) were examined. The cause and            in the nitrol patch group. There was no significant differences in the
mode of death were ascertained and confirmed pathologically. Acute            placebo group for all doppler indices during and after treatment.
anoxic death (AA) was diagnosed where an apparently normally grown            Conclusion: Transdermal nitroglycerin affects uterine and umbilical
infant had thoracic petechiac (68 cases) while for chronic anoxia (CA)        blood flow in preeclampsia by decreasing the vascular resistance as
various criteria were used including weight <10th centile and organ           measured by the doppler indices.
asymmetry (24 cases).
Results: As expected, there was a highly significant difference (p<0.001)
between the groups in liver/brain ratio (AA=0.343, (SD) 0.101,                FC1.07.07
CA=0.208 (SD) 0.062) and fetal weight, (AA,=1251g (SD) 673g                   VELOCITOMETRY OF A UTERINA AND MARKERS OF
CA=921g (SD) 419g) but there was no significant difference in PI              ENDOTHELIAL DAMAGE (ICAM-1, VCAM-1) IN PREDICTION
between the 2 groups (AA=2.077 (SD) 0.362, CA=1.951 (SD) 0.376).              OF PRE-ECLAMPSIA IN THE IST HALF OF PREGNANCY.
Significances determined by 2 sample Student’s T-test.                        P. Janku, V. Unzeitig, M. Drábková, K. Janku, T. Burnog, J. Paseka,
Conclusions: PI is a poor predictor of the asymmetric organ growth seen       Ist Dept. of Gynecology and Obstetrics, Masaryk University Brno, Czech
in severe IUGR.                                                               Republic.

                                                                              Objective: Clinical symptoms of preeclampsia are apparent as late as in
FC1.07.05                                                                     the 2nd half of pregnancy. But already during the first half of pregnancy
OUTCOME OF PREGNANCIES WITH VASA PREVIA                                       disorders of the trophoblast invasion and a damage of small vessel
K.O.Oyelese1, R.MacLaren1, K.M.Lewis1, S.Campbell2, J.T.Queenan1,             endothelium occure. The aim of our study is to find out whether it is
1.Dept.Ob/Gyn, Georgetown University Medical Center, Washington               possible to prove a disorder of the flow in the a. uterina and to detect
DC, USA. 2.Dept Ob/Gyn, St George’s Hospital, London,United                   markers of the endothelial injury ICAM-1(intracelular adhesive
Kingdom                                                                       molecules), VCAM-1 (vascular adhesive molecules) at patients with late
                                                                              symptoms of preeclampsia already in the 1st half of pregnancy.
Objective: The aim of this study was to determine if prenatal diagnosis       Study Methods: 224 pregnant women were followed up during the years
of vasa previa made a difference to fetal outcome.                            1999-2000. In the10-14 and the 18-22 weeks of gravidity velocitometry
Study Method: We reviewed the medical records of all women with a             of the uterine artery - index of pulsatility (PI) and resistance (RI) were
diagnosis of vasa previa over the past 5 years in two major teaching          examined and ICAM-1, VCAM-1 was determined. Velocitometry was
hospitals. We identified 5 cases, 4 of whom had the diagnosis made            examined by ultrasound Acuson 128 XP/4. VCAM-1, ICAM-1 was
prenatally. We sought to determine if making the diagnosis prenatally         determined by the ELISA method. During pregnancy and puerperium
made any difference to fetal outcome.                                         the patients were checked up for clinical and laboratory signs of
Results: In four of the five cases, a prenatal diagnosis of vasa previa was   preeclampsia (hypertension, proteinuria, oedema). The control group
made using transvaginal sonography and color Doppler. In three of             consists of healthy pregnant women. Statistical analysis was made by the
these, delivery was by elective Cesarean section. The babies survived         t-test.
without any complications. In the fourth case diagnosed prenatally, the       Results: The preeclampsia group consists of 12 women. The mean value
patient was delivered by emergency Cesarean at 25 weeks gestation for         of ICAM-1=206,35 ng/ml (SD 16,32), VCAM-1=603,67 ng/ml (SD
antepartum hemorrhage; this baby died at 4 days of life from sepsis and       47,14), RI =0,62 (SD 0,12), PI=1,61 (SD 0,32) in the10-14 week of
prematurity. In the one case that was not diagnosed prenatally, the           pregnancy and ICAM-1=198,65 ng/ml (SD 39,93), VCAM-1=593,5
membranes ruptured spontaneously at home with fetal exsanguination            ng/ml (SD 32,5), RI=0,89 (SD 0,09), PI= 1,3 (SD 0,15) in the 18-22
and demise.                                                                   week. The control group (n=212): ICAM-1=203,15 ng/ml (SD 46,91),
Conclusion: Vasa previa can be diagnosed prenatally using transvaginal        VCAM-1=595,36 (SD 114,72) PI=1,52 (SD 0,63), RI=0,70 (SD 0,14) in
sonography and color Doppler. When the diagnosis is made prenatally           the 10-14 week and ICAM-1=211,66 (SD 45,56), VCAM-1=613,08 (SD
and the fetus is delivered by elective Cesarean section, the prognosis is     111,19) PI=1,16(SD 0,49) a RI=0,62 (SD 0,13) in the 18-22 week of
excellent, whereas the risk of fetal mortality from exsanguination is high    pregnancy. As far as ICAM-1, VCAM-1 is concerned there was not
when the diagnosis has not been made prenatally. Every effort should be       found a statistic significant difference between patients with
MONDAY, SEPTEMBER 4                                                                                                                                   27

preeclampsia and with the control group patients. A statistical significant   Study methods: Prospective cohort study conducted in the National
difference (p<0,001) of RI a. uterina in the 18-22 week was found.            Maternity Hospital, Dublin, on 4915 low risk women in labor at 36-41
Conclusions: We did not prove that with the patients with clinical signs      weeks’ gestation, recruited to a clinical trial between 18th August 1997
of preeclampsia in the 2nd half of pregnancy a significant elevation of       to 20th August 1999. Women whose temperature exceeded 37.5OC in
adhesive molecules ICAM-1, VCAM-1 could be already detected in the            labor were compared with those whose temperature remained normal,
1st half of pregnancy. With the patients with the late manifestation of       using chi squared or t-test as appropriate.
preeclampsia, the RI of a. uterina may be proved allready in the 18-20        After identification of crude associations of maternal fever, logistic
week of pregnancy.                                                            regression using intrapartum co-variates was performed to calculate an
The study was supported by the grant of IGA Ministery of Health NH            adjusted odds ratio for fever and adverse neonatal outcome.
5733-3                                                                        Results: Neonatal encephalopathy occurred after 3.25/1000 births. The
                                                                              incidence of intrapartum fever was 6.8%. Univariate analysis showed
                                                                              maternal fever was associated with epidural analgesia, nulliparity,
FC1.07.08                                                                     induction, longer labour, oxytocin usage, greater fetal birthweight and
RESULTS OF COMPUTER-AIDED ULTRASOUND PROGNOSIS                                gestational age and instrumental vaginal delivery, but not with
OF FULL FETAL MATURITY                                                        prolonged (>24hrs) pre-labour rupture of the membranes. Maternal fever
M. Balajewicz, T. Gorecki, R. Klimek, R. Wojcik, Dept. OB/GYN,                was strongly associated with neonatal encephalopathy (crude OR 10.8,
Jagiellonian University, Cracow, Poland.                                      95% CI 4.0-29.3). The association persisted after adjusting for these co-
                                                                              variates (adjusted OR 4.72, 95% CI 1.28-17.4).
Objectives: The process of fetal maturation as a time-spatial event           Conclusions: Maternal intrapartum fever is a significant risk factor for
enables fetal maturity assessment based on the ultrasonographic               neonatal encephalopathy that is independent of known intrapartum risk
evaluation of the increased rate of spatial fetal parameters. It also makes   factors. The assumptions made in this method of analysis probably
possible determining the date of full fetal maturity with an accuracy of      underestimate the actual risk. Whether the association is casual or causal
days – instead of weeks from the date. To object of the study was to          cannot be determined from these data.
difine the frequency of slowly, regularly and fast maturating fetuses in
pregnancies after the infertility treatment as well as those complicated
by diabetes in comparison with physiological pregnancies.                     FC1.08.02
Study Methods: 502 pregnant women with diabetes, 280 after pregnancy          THE EVIDENCE FOR USING DOPPLER ULTRASOUND IN HIGH-
treatment, and 3 200 with physiological pregnancies were included in          RISK PREGNANCIES - A RE-ANALYSIS SEEN FROM THE VIEW
this prospective study. Maturity of fetuses was assessed ³28th week by        OF A HEALTH TECHNOLOGY ASSESSMENT (HTA).
means of M. Klimek’s computer aided method; maturity was defined as           HB Westergaard1, J Langhoff-Roos1, G Lingman2, K Marsál2. Dept.
“full” with 33 or more points in Ballard-Klimek’s scale.                      Ob/Gyn, University Hospital 1Rigshospitalet, Copenhagen, Denmark.
Results: In contrast to physiological pregnancies characterized by the          Lund, Sweden.
normal distribution of full maturity with the regular growth in 59% of
cases, in women pregnant after infertility treatment there was found          Objectives: To analyze the randomized controlled trials on the use of
statistically significant predominance of fast (43%) over slowly (11%)        Doppler ultrasound in high-risk pregnancies seen from the view of a
maturating fetuses. This ratio was similar in the group of pregnant           HTA and to identify those pregnancies that can benefit from the
women with diabetes (38.4% vs. 12%). In the presence of complications         examination.
connected with diabetes (19.9% of cases) this proportion was higher           Study methods: In 13 published randomized controlled trials a total of
(58.9% vs. 2.2%).                                                             8.588 high-risk pregnancies with nonmalformed fetuses were included.
Conclusions: The computer-aided full-maturity and birth-term                  Six trials included only singleton pregnancies with SGA and/or
assessment with accuracy of ±3 days without knowing the LMP is very           preeclampsia (2148 pregnancies) (Group A), and 7 trials included
efficient but co-existing mother’s diseases have to be taken into account.    pregnancies with a variety of complications or risk factors (Group B).
                                                                              Results: The number of perinatal deaths on nonmalformed fetuses was
                                                                              reduced when using Doppler ultrasound, totally: OR 0,63 (CI 95% 0,44-
FC1.07.09                                                                     0,91), group A: 0,66 (0,36-1,22), group B: 0,64 (0,41-0,99). In group A
HYPERCOILED CORD AND INTRAUTERINE GROWTH-                                     24 of 25 described nonmalformed perinatal deaths were caused by
RESTRICTED FETUSES                                                            placental insufficiency or abruption, in group B 21%.
L. I. Titchenko, J. U. Pyrsikova, Moscow Regional Research Institute of       Only in group A the use of Doppler ultrasound significantly reduced
Obstetrics and Gynecology, Moscow, Russia.                                    interventions such as antenatal admission 0,56 (0,43-0,72); induction of
                                                                              labour 0,78 (0,63-0,96); elective delivery 0,73 (0,61-0,88) and
Objectives: The aim of this study was to determine the relationship           emergency CS 0,78 (0,61-1,00).
between hypercoiled umbilical cord and fetal growth restriction.              Conclusion: There is a significant benefit from using Doppler ultrasound
Study Methods: Thirty-five fetuses were sonographic studied at third          on the overall mortality and regarding pregnancies with SGA and/or
term of pregnancy. Flow velocity waveforms of the umbilical cord              preeclampsia also on interventions in antenatal care and during delivery.
arteries and fetus aorta were analysed. Fetal growth retardation was          However for many high-risk pregnancies application of the technique
measured as standard deviations from gestational weight.                      does not seem to be appropriate as elective delivery subsequent to an
Results: Doppler flow characteristics (systolo-dyastolic ratio, resistance    abnormal Doppler ultrasound will only improve outcome if the
index) were significantly increased in hypercoiled umbilical cord, in 23      underlying cause of the abnormal testing is placental insufficiency.
cases (66%, p<0.05) Coiling index was 0.61 ± 0.14 coils/cm. Growth-
restricted fetuses were determined in 16 cases (46%, p<0.05).
Conclusions: Hypercoiled cord can be studied by ultrasound and                FC1.08.03
correlated with antenatal fetal hypoxia and fetal growth restriction.         EXTRAOVULAR PLACEMENT OF INTRAUTERINE PRESSURE
                                                                              CATHETERS IN LABORING PATIENTS
                                                                              W.D. Wallace (1), B.K. Lind (2),
FC1.08 FETAL MONITORING 1                                                     (1) University of Utah, Salt Lake City, UT, USA.
                                                                              (2) American Fork Hospital, American Fork, UT, USA.
INTRAPARTUM FEVER AND NEONATAL ENCEPHALOPATHY                                 Objectives: To determine the frequency of intrauterine pressure catheter
L Impey, C Greenwood, John Radcliffe Hospital, Oxford OX3 9DU, UK             placement outside the amniotic membranes (extraovular) during labor
K MacQuillan, M Reynolds, O Sheil, National Maternity Hospital,               and delivery.
Dublin, Ireland                                                               Study Methods: 73 laboring patients participated with three types of
                                                                              catheters used: 39 Koala™, 20 Intran® Plus, and 14 fluid-filled Isoflo™.
Objectives: Previous case control studies have reported that maternal         Multiple intrauterine pressure catheter placement attempts with the same
intrapartum fever is associated with an increased risk of neonatal            catheter were made resulting in one of three end points, determined by
depression and neonatal encephalopathy. Our aim was to determine              fluid in the catheter lumen: (1) amniotic fluid visualized, (2) blood
whether this is independent of other associated intrapartum risk factors.     visualized, (3) no fluid or blood visualized. Indigo carmine was used as
28                                                                                                                        MONDAY, SEPTEMBER 4

an indicator on the chorioamniotic membrane to document catheter tip          Conclusions: Our data lend further support to the validity of the use of
location.                                                                     Doppler velocimetry in identifying fetal acidosis or involvement
Results: After multiple insertion attempts, 13.7% of catheters were
confirmed with indigo carmine or blood to be extraovular (confidence
limit 95%). Upon first catheter insertion, 38% showed no amniotic fluid       FC1.08.06
return indicating possible extraovular location. The percentage of            DOPPLER PULSATILITY INDEX OF THE FETAL RENAL
amniotic space placements increased with the number of insertion              ARTERY IN NORMAL PREGNANCIES – A PROSPECTIVE STUDY
attempts.                                                                     M.J. Franco N. R. Silva; R.B.R.G. Bornia; R.M. Sá; A. A. Cunha; L. G.
Conclusions: Intrauterine catheters placed in pregnant laboring women         P. da Silva. Dept OB/ GYN - Maternidade Escola - Faculdade de
to monitor contractions are often inserted outside the amniotic               Medicina - Universidade Federal do Rio de Janeiro- Rio de Janeiro - RJ
membranes without the clinician’s recognition. This can result in             - BRASIL
artifactural pressure readings and complications such as placental            Rua Senador Vergueiro 200 ap 715 Rio de Janeiro RJ BRASIL CEP
perforation or abruption, uterine perforation, fetal heart rate tracing       22230-001
abnormalities, and placental abruption due to amnioinfusion outside the
membranes.                                                                    Objective. To obtain reference ranges from the pulsatility index of the
                                                                              fetal renal artery between 24 and 40 weeks’ gestation.
                                                                              Study Methods. We carried out a prospective, cross-sectional analisys on
FC1.08.04                                                                     24 clinically normal singleton pregnancies. We took 324 examinations
DUCTUS VENOSUS VELOCIMETRY IN NORMAL PREGNANCY                                on these patients who came from our Instituition
M. Sá Renato, H. Chaves Netto, J. Amim Jr., N.R. Silva, R.B.R.G.              (Maternidade-Escola da UFRJ) or private offices. Their last menstrual
Bornia, M.J. Franco, A.A. Cunha, Dept. OB/GYN, Maternidade Escola,            period was confirmed by ultrasonographic biometry on early second
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, RJ,            trimester. At the moment of the examination, all patients had normal
Brazil.                                                                       laboratory findings. We have obtained the pulsatilility index of the fetal
                                                                              renal artery with either HITACHI EUB-515 or TOSHIBA SSA 340A
Objective: To observe ductus venosus velocimetry in normal pregnancy.         dynamic ultrasound scanners with color doppler duplex, using convex
Study Methods                                                                 transducers of 3.5 Mz and 3.75Mz. Regression analisys was used with
A total of 184 pregnant women were studied while receiving care at the        the statistic package “Statgraphics v. 6.0 – Statistics Graphics
Clinica de Ultra-sonografia da Barra Ltda. in Rio de Janeiro, Brazil.         Corporation”
Patients knew the exact last menstrual date and had no clinical or            Results. We assumed that the pulsatility index of the fetal renal artery is
obstetrical complications at the time of examination. Ultrasound              function of gestation. Linear regression analisys was used to obtain the
evaluation was performed in patients with a singleton gestation from18        equation PI= 3,66 – 0.657 GA (GA= gestational age)
to 36 weeks. Patients were scanned using a SSH-140 A (Toshiba                 Conclusion. Our results shows that the pulsatility index of the fetal renal
Corporation) curvilinear ultrasound transducer with a frequency of 3.75       artery decreases with advancing gestation.
MHz. The ductus venosus was identified with the help of color Doppler
and it was considered insonation sight both istmus and outlet portion of
the ductus. We used the S/A (PVS/PVA) index for the statistical analysis      FC1.08.08
and the group’s average was calculated.                                       ANTENATAL HUMAN FETAL BRAIN MAPPING
Results: The ratio S/A was 2.37 ± 0.68 along all the gestational age (18-     *S. Vadeyar, School of Human Development, University and City
36 weeks; n=184, test F=0.77, p=0.73, df=18). The extreme values were:        Hospitals, University of Nottingham, United Kingdom. R J Moore,
5th percentile=1.5, 10th percentile=1.6, 50th percentile=2.3, 90th            Magnetic Resonance Centre, Department of Physics & Astronomy,
percentile=3.3, 95th percentile=3.6.                                          University of Nottingham, United Kingdom
Conclusions: After the result of the variance analyses we concluded that      C Gribbin, School of Human Development, University and City
the S/A index for the ductus venosus presents a stable behavior               Hospitals, University of Nottingham. United Kingdom
throughout the normal pregnancy from 18 to 36 weeks.                          P N Baker, School of Human Development, University and City
                                                                              Hospitals, University of Nottingham, United Kingdom
                                                                              D K James, School of Human Development, University and City
FC1.08.05                                                                     Hospitals, University of Nottingham, United Kingdom
THE EFFICACY OF DOPPLER VELOCIMETRY IN IDENTIFYING                            P A Gowland, Magnetic Resonance Centre, Department of Physics &
FETAL ACID-BASE STATUS AND WELL-BEING                                         Astronomy, University of Nottingham, United Kingdom.
C.M.M.O. Franzin, J.L.P. Silva, S.V. Parmegiani.
OB/GYN Dept., State University of Campinas, Campinas, Sao Paulo,              Aims: The majority of cases of neurodevelopmental problems have their
Brazil                                                                        origin in the antenatal period. This study aims to provide direct evidence
                                                                              of fetal brain cortical activity in utero, using the technique of functional
Objective: Evaluate the capacity of the Doppler study in the diagnosis of     magnetic resonance imaging (fMRI).
fetal acid-base status and well-being.                                        Methods: Sixteen pregnant volunteers with a singleton fetus at 36-41
Study Methods: 130 pregnant women, between 28th and 42nd weeks of             weeks. Twelve subjects had an auditory stimulus to the fetus while four
gestation, were studied at of the Center of Integral Attention to Women's     had the stimulus played to the mother (controls). The auditory stimulus,
Health. Correlations were made among the results of the Doppler               delivered via headphones, was presented for 15 seconds followed by a
velocimetry of the umbilical, middle cerebral and fetal abdominal aorta       15 seconds of silence, and this cycle was repeated 18 times. Two images
arteries and the blood gases of the newborn and adverse perinatal results.    were acquired per second for each slice selected. The data was corrected
The pregnant women selected for the study underwent elective cesarean         for fetal motion. The signal in each pixel of the fetal brain was averaged
sections no later than four hours after the Doppler study. Blood for the      to produce a single time course for each pixel. An fMRI activation map
gasometry tests was obtained by funicular puncture immediately after          was produced by highlighting the pixels in which the signal correlated
birth. The S/D<3 ratio was used as standard of normality values for the       significantly to the stimulus.
umbilical artery blood results; for the Pulsatility and Resistance indexes,   Results: Two mothers (2/12) moved too much and the data was not
the normality values tables from the Harris Birthright Research Center        analysable. Five (5/12) fetuses showed activation in one or both
for Fetal Medicine were used.                                                 temporal lobes, which was statistically significant (p<0.005). Temporal
Results: The Doppler velocimetry of the vessels showed a statistically        lobe activation that approached statistical significance (p0.009, 0.039)
significant association with altered fetal blood gases and adverse            was seen in 2/12 fetuses. In three cases data could not be used due to
perinatal results. The S/D ratio of the umbilical artery showed greater       susceptibility artifacts. None of the controls showed activation.
sensitivity (71.4 %) in the diagnosis of fetal acidemia and adverse           Conclusions: This is the first report of fetal fMRI as a novel method of
perinatal results (80.8 %) than the IP and the IR of the umbilical artery.    understanding antenatal brain function and demonstrating fetal sensory
The Doppler study of the umbilical artery showed better sensitivity than      competency. This technique has the potential to become a powerful tool
that of the middle cerebral artery and the abdominal aorta in the             in investigating brain development.
detection of adverse perinatal results.
MONDAY, SEPTEMBER 4                                                                                                                                  29

FC1.08.09                                                                    and painful. Heparin should not be used with SCDs unless an additional
FETAL MIDDLE CEREBRAL ARTERY BLOOD FLOW IN                                   benefit can be demonstrated in a randomized control trial.
V. E. Radzinskiy, B. S. Demidov, Dept. OB/GYN, Maternity Hospital N          FC1.09.02
25, Russian Peoples’ Friendship University, Moscow, Russia.                  URINARY INCONTINENCE IN GYNECOLOGIC ONCOLOGY
Objectives: The well known effect of blood flow redistribution               G.Del Priore, S.Taylor, Y.Martas, M.Silverstein, R.J. Masch, NYU
characterized by low resistance in the fetal MCA (brain-sparing effect)      School of Medicine, 530 First avenue, suite 9R, New York, NY, United
is a rather seldom finding and is a part of physiological compensatory       States, 10016.
reaction on severe fetal hypoxia. On the contrary abnormally high
resistance in the fetal cerebral arteries is much more frequent Doppler      Objectives : Urinary incontinence (UI) is a major cause of morbidity
finding in the third trimester of pregnancy. In the present study we         throughout the United States but has not been completely studied in
attempted to evaluate cerebral arterial blood flow in women with             Gynecologic Oncology (GO) patients. Since endometrial cancer patients
different forms of placental insufficiency.                                  share risk factors with UI patients, we sought to determine the
Study Methods: 107 pregnant women were examined in terms 25-39               prevalence and significance of UI in these and other GO patients and to
w.g. Doppler examination of umbilical artery (UA), intraplacental (IPA)      determine the ability of a GO practice to elicit UI symptoms.
arteries and MCA blood flow was performed. Coefficients of placental         Methods : Using the Urogenital Distress Inventory (UDI) and the
resistance were calculated as ratio between UA and IPA PI. All patients      Incontinence Impact Questionnaire (IIQ), 80 recently seen patients were
were retrospectively divided into three groups: 18 with elevated UA PI,      queried by a single investigator. A control group of 40 patients from a
46 with normal UA PI but UA/IPA ratio less than 1 and 43 controls with       primary care Ob-Gyn practice was included for comparison.
normal UA PI and UA/IPA ratio >1. MCA flow in those groups was               Results : The mean age was 54.2yrs with 50% being menopausal; 43%
compared as well as pregnancy outcome.                                       had at least one delivery and 79% were Caucasian. Forty-three of the
Results: In the first group 4 (22.22% fetuses demonstrated the brain-        questionnaire participants(54%) reported at least 1 symptom of
sparing effect after 35 w.g. in combination with fetal distress diagnosed    incontinence with 19%(n=15) complaining of severe symptoms that
by cardiotocography (CTG). In 9 (50%) of cases in the first group we         impacted on their activities of daily living. The prevalence of UI did not
detected normal blood flow in MCA and normal MCA/UA ratio,                   vary by primary cancer site. Unfortunately 84%(36/43) patients were not
however 6 of those fetuses demonstrated abnormal CTG. In 5 (27.78%)          diagnosed by either practice including 73%(11/15) patients with severe
cases in the first group we observed elevated PI values in MCA,              symptoms. The GO practice was no worse at eliciting urinary symptoms
MCA/UA ratio was still within normal range. In the second group we           than the primary care Ob-Gyn practice. Of the 43 patients with a positive
have not observed brain-sparing effect, in 17 (36.96%) cases MCA PI          response undetected by the providers, there was no association with age,
was relatively higher but between 1ts and 2d SD. We found statistically      race or marital status. In a multivariate analysis, there was no single
significant (p<0.001) difference in the PI values in MCA between the         question or demographic factor that emerged as the best discriminator of
2dn group and other groups of patients included in our trial.                a positive response to the UDI or IIQ questionnaire. Patients were
Conclusions: Subcompensated stages of placental insufficiency                significantly more likely to report a positive response on the
characterized by UA/IPA PI <1 is often associated with high resistance       questionnaire than their provider was able to elicit during an office visit
flow in the fetal MCA, that leads to numerous complications in the early     (OR=17.4;X2 p<.001).
neonatal period.                                                             Conclusions : A significantly number of patients report UI symptoms,
                                                                             including 73% of patients with severe complaints, that neither a GO or
                                                                             general Ob-Gyn practice detects during a routine office visit. Since
FC1.09 GYNECOLOGICAL ONCOLOGY                                                treatment can only follow detection, providers should consider measures
                                                                             that may bring about a more accurate assessment of UI in their patient
FC1.09.01                                                                    population. Theoretically, coordinating treatments in a patient with
A COMPARISON OF THROMBOEMBOLIC PROPHYLAXIS IN                                endometrial cancer and UI may avoid multiple surgical interventions.
M.Ailawadi, G.Del Priore, New York University School of Medicine,
550 First Avenue, Suite 9R, New York, NY, United States, 10016.              FC1.09.03
                                                                             SQUAMOUS CARCINOMA OF THE VAGINA: TREATMENT AND
Objective: The aim of the study was to compare two methods of                LONG-TERM FOLLOW-UP
thromboembolic prophylaxis, sequential compression devices (SCDs)            W. Tjalma1,2, J. Monaghan1, R. Naik1, A. de Barros Lopes1.
alone versus SCDs with subcutaneous heparin.                                 Department of Gynaecological Oncology, 1Queen Elizabeth Hospital,
Methods: A retrospective case-control chart review was conducted on          Gateshead, U.K. & 2Antwerp University Hospital, Antwerp, Belgium
one hundred and sixty eight patients who had underwent surgery for
suspected gynecological malignancies. These patients were examined           Objective: Primary cancer of the vagina is rare and was thought to be
for associated risk factors, method of prophylaxis, and incidence of         almost universally fatal (Taussig 1935). More than 80 % of the cancers
clinically significant thromboembolic events. Of these patients, 94          are of squamous origin. Due to a lack of experiences the treatment
(56%) received perioperative and postoperative sequential compression        modality is frequently inappropriate. Current report describes the
devices (SCDs) while 74 (44%) received both SCDs and subcutaneous            management of squamous vaginal tumors in a referral center over the
heparin. The postoperative course of these patients both while in the        last 25 years.
hospital and after discharge was followed for clinically evident             Study Methods: The medical records of 55 patients treated for primary
thromboembolic complications. Univariate and multivariate analyses           squamous vaginal carcinoma at the Northern Regional Gynaecological
were performed.                                                              Oncology Department (U.K.) between 1974 - 1999 were reviewed.
Results: The two groups were comparable in terms of most risk factors        Results: The mean age of diagnosis was 58 years (range 34 - 90). The
including age, stage, height, weight, body surface area, estimated blood     main symptom was vaginal discharge (62%) with a median history
loss, total anesthesia time and nodal disease. Six of ninety-four patients   lengths of 4 months. The FIGO stage was I: 27; II: 12 ; III: 6 and IV: 10.
(6.4%) in the SCDs group suffered from venous thromboembolism,               A total of 54 % received radical surgery and 13 % had a local excision
while four of seventy-four (5.4%) patients who received both SCDs and        either with or without radiotherapy. Primary radiotherapy was given in
heparin had a thromboembolic event(&#61539;2 p=.79). There was no            33 %. No patients were lost for follow-up and the median follow-up
difference in postoperative changes in platelet counts between the two       period was 45 months (range 0.6 - 268). The overall survival for 5, 10,
groups. Heparin added additional cost, 105 extra minutes of nursing time     15 and 20 years were respectively 74 %, 58 %, 58 % and 29 %.
per patient per admission, and additional pain for the patient.              Conclusions: Centralization of these rare tumors leads to an increase in
Conclusion: Subcutaneous heparin does not appear to add any                  experience for physicians and more important to a significant improved
prophylactic benefit to SCDs in preventing thromboembolic                    survival for the patients.
complications postoperatively in patients with gynecologic
malignancies. In addition, heparin is more expensive, time consuming,
30                                                                                                                      MONDAY, SEPTEMBER 4

FC1.09.04                                                                    Results: The majority of women were in fifth & sixth decade. The most
GENITAL CANCER IN MARRIAGE: IS THERE ANY                                     common symptom was pruritis vulva seen in 39 cases (71%). Sixty four
RELATIONSHIP?                                                                percent of women were postmenopausal. Labia majora was involved in
T. Iversen and S. Harvei, Dept.of Oncology, Ullevaal Hospital and the        47 (85.45%) of patients. Hyperplastic dystrophy was the most frequent
Cancer Registry of Norway, Oslo, Norway                                      histologic variant, which constitutes 23 cases (41.81%). Topical
                                                                             corticosteroid was the commonest medical therapy instituted (76%).
Objective: To examine the possible relationship of prostate cancer in        Surgery was done for resistant, cases and cases with moderate to severe
males and cervical and breast cancer in females in married couples.          atypia. Simple vulvectomy was the commonest surgical procedure
Study Methods: 26 830 wives of 36 872 prostate cancer patients were          performed. Subjective as well as objective improvement was better seen
compared with 26 731 wives of men who did not have this disease. In          in cases of lichen sclerosis as histologic variant. Progression to
the same period, 1960-92, 6536 husbands of 10 676 women with                 malignancy was not noted in any cases during follow up.
squamous cell carcinoma of the cervix uteri were compared with 6537          Conclusions: Medical therapy is the mainstay of treatment. Surgery is
husbands married to women without cervical cancer.                           advocated only when medical therapy fails or patients having atypia.
Results: The odds ratio for all types of malignant disease was 0.99          Subjective and objective response was better in cases of lichen sclerosis.
among wives of patients with cancer of the prostate gland compared           The risk of malignant progression is unlikely. Long term surveillance is
with the control group. As to breast cancer the odds ratio was 1.03. The     recommended to know the potential for malignancy even after
risk of pre-invasive and invasive squamous cell carcinoma of the uterine     vulvectomy, because of its multifocal nature.
cervix was 1.05 and 0.83 respectively. As to husbands married to
women with squamous cell carcinoma of the uterine cervix, the odds
ratio was 0.83 for prostate cancer and 0.89 for total number of men with     FC1.09.07
invasive cancer.                                                             MINIMAL SURGERY IN VULVAR CARCINOMA
Conclusion: No positive correlation between cancer of the prostate gland     T. Maseela, Dept. OB/GYN/Oncology, MEDUNSA, Bloemfontein,
among husbands and pre- or invasive cancer of the uterine cervix or the      South Africa.
breast of the wives was found.
                                                                             Objectives: Carcinoma of the vulva, with an incidence of 1.1%, rates 6th
                                                                             among malignant diseases of the female organs treated in our Institute.
FC1.09.05                                                                    The mean age is 46 years. The rural origin of 73% of the patients
PSYCHOSOCIAL ADJUSTMENT AFTER GYNECOLOGIC                                    accounts for extremely late presentation. The aim of the study was to
CANCER TREATMENT: A LONGITUDINAL STUDY ON RISK                               establish the efficacy of combined treatment modality with
FACTOR FOR MALADJUSTMENT                                                     chemotherapy and minimal surgery.
Y.M. Chan, H.Y.S Ngan, P.S.F. Yip, B.Y.G. Li, O.W.K. Lau, G.W.K.             Study Methods: 15 cases of advanced Ca-vulva (FIGO-II-III) were
Tang, Dept. OB/GYN, Dept. Statistics & Actuarial Science, University         entered to the study over a period of 2 years. The prognostic factors
of Hong kong, Hong Kong SAR, China.                                          were analyzed before initiation of therapy, which was neo-adjuvant
                                                                             chemotherapy (NAC) with platin-based combinations, followed by
Objectives: The objective was to describe the change of psychosocial         bilateral groin-dissection and electroresection of the tumor.
state over time and to identify risk factors for maladjustment in patients   Results: The surgical-pathological staging (SPS) was in 80% (T2 N1Mo-
with gynecologic cancer. Awareness of these issues is important for          T3N2MO) inclusive, and in 20% T2N3MO-T4N2-Mx. Hospital stay was
planning supportive care services for cancer patients.                       post-operatively 16-21 days and duration of treatment 4 month.
Study Methods: A prospective longitudinal study of patients with newly       Cosmetic results were good and psychological balance remarkable.
diagnosed gynecologic cancer was performed. Patients were interviewed        Conclusion: Limitations of equipment availability for ionizing radiation
after confirmation of the diagnosis, and were reassessed at 6 and 18         in developing countries compels us to seek feasible treatment modalities.
months after completion of treatment. Psychological adjustment was           The method introduced by WEGHAUPT seems to be cost effective and
measured by self-rating on self-esteem, outlook on life, self-role, and      practical.
femininity. Neuroticism and anxiety were assessed using a neuroticism
score and the Hamilton Anxiety Scale. Depressive symptoms were asked
directly. Social adjustment was assessed by the change of working            FC1.09.08
capacity or work status, leisure activity and the change in marital          SURGERY IN OBESE GYNECOLOGICAL CANCER WOMEN
relationship and sexual activity. A cumulative logic model was used          AGED > 70 YEARS
with individual patients as their own control. Data analysis was             R. Giannice1, R. Carminati2, A. Poerio1, P.A. Margariti1, T. Susini1,
performed by the Spearman’s Rank Correlation.                                S. Mancuso1 and G. Scambia1.
Results: Seventy-four women participated. Adjustment problems did not          Dept. OB/GYN, Catholic University of the Sacred Heart of Rome,
occur in majority of patients. Psychosocial adjustment was different for     Italy;
patients receiving different types of treatments. Improvement in               Dept. OB/GYN, Civil Hospital of Legnano, Italy
feminism (p=0.050) and neuroticism (p=0.010) was observed for
patients receiving chemotherapy and deterioration was observed in            Objectives: Obesity and advanced age are considered aggravating
patients treated with surgery. Deterioration in neuroticism was              conditions for surgical risk. The aim of the study was to analyse
associated with lower education level (p=0.032). With religious belief,      feasibility and morbidity of surgery performed on obese gynecological
there was better family support and ore significant improvement in           cancer patients aged >70 years.
social activity (p=0.038).                                                   Study Methods: From January 1986-December 1999 we collected all
Conclusions: Most patients adapted well. Patients at risk for                women aged > 70 years operated for ovarian, cervical and endometrial
psychosocial maladjustment include those who are treated surgically,         cancer. All obese patients with Body Mass Index (BMI) >30 were in
less educated, and without religious belief.                                 study group (A). Control group (B) was obtained from patients with
                                                                             BMI <30, matched, with obese patients, for: age, ASA risk,
                                                                             comorbidities, surgical procedures, tumor site and stage. Fisher’s exact,
FC1.09.06                                                                    Chi-Square and Mann-Whitney U-tests were used for statistical analysis.
VULVAL DYSTROPHY: AN EXPERIENCE IN A REGIONAL                                Results: In a total of 181, we collected 45 obese and 136 normal-weight
CANCER CENTER IN INDIA                                                       patients. In obese, compared with overall normal-weight patients, were
A.P. Manjunath, A.S. Kapadia, K.S. Dave, A.D. Desai and S.M. Patel.          more frequent diabetes (35% vs 15%, P<.05), hypertension (69% vs
Dept. Gynecologic Oncology, The Gujarat Cancer & Research Institute,         40%, P<.01) and endometrial cancer (67% vs 55%, P=NS). Groups A
Ahmedabad, Gujarat State, India, 380016.                                     (N=45) and B (N=45) consisted of: 11% cervical, 22% ovarian and 67%
                                                                             endometrial cancer. Extensive procedures were performed in 24% of
Objectives: To study the clinical presentation, response to therapy of       both groups. Both groups did not significantly differ for: median
vulval dystrophy and to evaluate the potential of vulval dystrophy in the    operative time (A=120 min. vs B=100 min.), intraoperative
development of malignancy.                                                   complications (A=7% vs B=9%), intraoperative transfusion (A=15% vs
Study methods: Fifty-five cases of vulval dystrophy studied from 1980-       B=13%), median blood loss (300 mL in both groups), postoperative
1998, at the Gujarat Cancer & Research Institute, Ahmedabad.
MONDAY, SEPTEMBER 4                                                                                                                                31

severe complications (A=7% vs B=13%) and median hospital stay (A= 8         effecting other oestrogen sensitive organs such as the endometrium. This
days vs B= 9 days). No patients died.                                       appears to be promising in that it contains the attraction of
Conclusions: In our series, obesity did not enhance surgical morbidity in   phytoestrogens with the potency of a SERM like molecule.
elderly oncological gynecological women.

FC1.09.09                                                                   ULTRASOUND ASSESSMENT OF THE BONE QUALITY OF
PATIENTS                                                                    IAO.Ujah1, I.Bond2, R. Dulai2, W. Wadinga1, D.J Vanderjagt2,
M.Desai, B.Desai, Blue Cross Nursing Home, Bahucharaji Road,                RH.Glew2.
Nagarwada, Vadodara, Gujarat, India, 390 002.                                 Dept. Obst/Vynae. Jos University Teaching Hospital, Jos, Nigeria
                                                                              Dept. Biochemistry and Molecular Biology, University of New
Objective: To determine the effect of Hormone replacement therapy on        Mexico, School of Medicine, Albuqurque, USA.
menopausal symptoms and urological complains following treatment of
cancer cervix                                                               Objectives : To assess the bone quality of postmenopausal Nigerian
Study Method: In 124 histologically proven Squamous cell carcinoma          women.
cervix patients a detailed history about menopausal symptoms and            Study Methods : The bone stiffness index of one hundred and fifteen
Urological complains was taken. All patients underwent a Standing           postmenopausal and one hundred and nineteen premenopausal Nigerian
Stress Test and Simple Cystometry before starting treatment, 6 weeks        women were compared using bone ultrasonometer (Lunar Corp,
after treatment and 3 months after Hormone Replacement                      Madison. W1 USA).
therapy.0.625mg of Conjugated Estrogen with 2.5mg of                        Results : The mean bone stiffness index for postmenopausal women was
Medroxyprogesterone acetate continuously were given as Hormone              82.9+23.2, compared to the mean value of 99.5+16.5 for premenopausal
replacement therapy.                                                        women.
Results: Menopausal symptoms of hot flushes was present in                  Conclusions : The study suggests that postmenopausal women in Nigeria
28%patients.Other symptoms were common to cancer cervix and                 may be at increased risk for osteoporosis and fracture.
menopause.25% patients had positive cystometry findings at the.time of
presentation.80% had stage III B disease and 73.4% were
postmenopausal women.Positive cystometry findings increased to 48.2%        FC1.10.03
following treatment,20% after surgery and 54.3% following                   COMPARISON OF ANTI-BONERESORPTIVE EFFECTS AMONG 5
Radiotherapy. 112 patients were evaluable for response to Hormone           HORMONE TRERAPIES
replacement therapy.Only 28.8% now demonstrated positive cystometry         S. Boonjong, S. Charnvises, P. Tiravaprakit, S. Naraong, Dept.
findings.The response was more among the premenopausal women than           OB/GYN Bhumibol Adulyadej Hospital, Bangkok, Thailand.
postmenopausal women.Menopausal complains also reduced by 70%.
More than 50 patients have completed one year on Hormone                    Objectives: To compare in levels of urinary N-Telopeptide (NTx) before
replacement therapy without any complications.                              and after receiving 5 hormone therapies for 3 months.
Conclusions: Hormone replacement therapy plays a significant role in        Study Methods
improving the Quality of life of Cancer Cervix patients.                    (1) Single-blind randomized controlled trial
                                                                            (2) Group 1(control): calcium carbonate 2 000mg/d.
                                                                            (3) Group 2: conjugated estrogens 0.625ng/d for 21 days plus
FC1.10 HRT AND THE SKELETON 1                                                     medrogestone 5 mg/d for last 10 days.
                                                                            (4) Group 3: estradiol valerate 2mg/d for 21 days plus norgestrel
FC1.10.01                                                                         .05mg/d for last 10 days.
PHYTOESTROGEN / SERMS LIKE ACTIVITY FROM A MARINE                           (5) Group 4: conjugated estrogen 0.625mg/d plus medroxy
ALGA DERIVED MOLECULE ON BONE DENSITY AND                                         progesterone acetate 2.5mg/d
COLLAGEN MARKERS IN POSTMENOPAUSAL WOMEN                                    (6) Group 5: tibolone 2.5 mg/d
R.Galea (1), S.Attard Montalto (1), M.Brincat (1), C.Saliba (2),            (7) Group 6: 17-b estradiol 2mg/d plus norethisterone acetate 1mg/d
M.Serrar (2), G.Gutierrez (2), J.P. Salles (3), (1) St. Luke's Hospital,    Statistics: Paired T-test, one-way Anowa ad multiple comparison by
University of Malta Medical School, Gwardamangia, Malta, MSD 07,            Scheffe test
(2) IBA, Malta., (3) Laphal Laboratoires, Allauch, France.                  Results
                                                                              Group       Numbers         NTx1-NTx2        Oneway Anova
Introduction and Objectives: A marine alga, Padina Pavonica, classified                                   NMBCE/Cr
as a food supplement, has been shown to have a group of oestrogen-like        1           65              -1.662
molecules with a positive effect on bone formation in cell line cultures.     2           63              17.32            Between groups
The aim of this study was to assess the possible effects of this alga on      3           67              19.11            <0.05
bone metabolism in postmenopausal women.
Design and methods: Forty postmenopausal women were randomised
                                                                              4          67              25.37
into of four groups each having a different dose. Group A acted as
                                                                              5          66              26.50
controls, while Group B, Group C, and Group D had 200mg, 400mg and
                                                                              6          65              36.00
600mg of the lyophilized alga respectively. Bone density was measured
at the lumbar spine and at the hip region using a bone densitometer         Conclusions: Each hormone therapies can reduce bone resorption
[DEXA-Norland 386] over one year. Chemical bone markers for bone            significantly but calcium supplement cannot.
formation [Procollagen I C end terminal] and bone resorption                Combined continuous regimens of hormone therapies have more anti-
[Pyridinium crosslinks] were also assayed. Endometrial thickness and        boneresorptive effects than combined sequential regimens.
vaginal cytology were also assessed.
Results: The bone density increased significantly at the lumbar spine
[Grp B=2.5%] [Grp C=4.6%] [Grp D=0.4%] and at the femur [Grp                FC1.10.04
B=5.3%] [Grp C=8.1%] [Grp D=0.3%] over the study period. The                BONE DENSITOMETRY IN PREMENOPAUSAL WOMEN WITH
collagen markers have shown a decrease in both bone formation and           HIGH RISK OF SECONDARY OSTEOPOROSIS
bone resorption with an overall balance in favor of bone formation. No      S. Sijanovic, I. Karner, Dept. OB/GYN, University Hospital, Osijeck,
effect was noted on either the endometrial thickness or the maturation      Croatia.
index of vaginal cytology.
Conclusions: The results show an increase in bone density and also a        Objective: The aim of this study was to determine whether the long-term
positive bone collagen status as evidenced by bone collagen markers         thyroxime therapy in postmenopausal period is a risk for development of
with no visible effect on either the endometrium or the vaginal cells.      secondary osteoporosis and whether those women have increased loss of
This marine alga contains potent phytoestogens with similar results as      bone mass during premenopausal period.
oestrogen on the bone metabolism. Like SERMs they do not seem to be
32                                                                                                                                      MONDAY, SEPTEMBER 4

Study Methods: There was a selected group of women in premenopausal                           Study Methods: In this 2-year, randomized, double blind, placebo
period (N=19), aging 39.0±8.0 suffering from differentiated thyroid                           controlled trial, 74 eligible women (postmenopausal, osteoporotic, and
gland carcinoma. To all of them, the total thyroidectomy was done and                         taking hormone replacement therapy for at least one year immediately
the thyroxine suppression therapy was introduced. The duration of the                         prior to study entry) were randomized to receive either hPTH 1-34 or
suppression therapy from the beginning of the research amounted to                            placebo for two years. In addition, they received daily, Premarin 0.625
9.4±6.4 years. Laboratory results have excluded other possible factors                        mg, medroxyprogesterone if needed, vitamin D 800IU, and calcium
for secondary osteoporiosis. The prospective study of the bone                                1500 mg. Lumbar spine, hip and forearm bone mineral density BMD
densiometry was done to all of the examinees using the method of dual                         were measured by dual energy absorptiometry (DXA) and lumbar spine
photon x-ray absorptiometry (DXA) of the spine and the femoral neck,                          and hip BMD by quantitative computed tomography (QCT).
and also by the method of single-photon absorptiometry (SPA) of the                           Results: A total of 60 subjects (81%) completed the treatment phase.
distal radius.                                                                                The median bone density change as measured by DXA were:
Results: In the beginning of this study, while the patients were treated                                          Lumbar Spine                     Femoral Neck
for 10 years osteopeny was found in the spine and the femoral neck in                                       Placebo            PTH           Placebo             PTH
two examinees for every region. On the distal radius osteopeny was                              6 mo          0.7%            9.2%*           0.2%              0.1%
found in 4 examinees. The total was 8 out of 19 with statistically                             12 mo          0.7%           20.6%*           0.0%             4.0%**
significant loss o f bone mass was in any region of skeleton. However,                         18 mo          0.6%           23.6%*           -0.1%            7.3%*
looking at the individual scores, osteopeny was found in 6 examinees on                        24 mo          0.9%           29.2%*           0.2%             11.0%*
the distal radius but on the spine and the femoral neck, there was bone                       *p<0.0001, **p=0.002 when compared with baseline.
loss in several women but not to the point that would create osteopeny.                       Of those randomized to PTH who had DXA at 24 months, 89% had
But, after the 4 years of measurement, t-test had shown some significant                      increases of lumbar spine BMD greater than the equivalent of 2
loss of bone mass on the distal radius. The period of one year is not                         population SD. Trabecular bone density in L1, L2 as measured with
enough to record significant bone loss.                                                       QCT, increased in the PTH group a median of 74% from baseline at 24
Conclusions: We can come to the decision that women who begin with a                          months (p=0.027) and decreased 2.1% in the placebo group.
long-term thyroxine therapy (about 10 years) in premenopausal period                          Conclusion: These findings indicate that combined hPTH 1-34 and
can develop osteopeny in the beginning of menopause. In that case,                            estrogen therapy is effective in producing large increases in bone density
those women should complete a mammography test and bone                                       at the lumbar spine and femoral neck. PTH is capable of restoring bone
densitometry before hormone replacement therapy is used.                                      mass above the osteopenic range in osteoporotic women.

FC1.10.05                                                                                     FC1.10.07
A. Mancini, R.M. Tacchino, D. Valle, M. Perrelli, A. Bianchi, A.                              A.S. Khodair, OB/GYN, Suez Canal University Hospital, Ismailia,
Giampietro, D. Milardi, C. Vezzosi, L. De Marinis, Dept.                                      EGYPT.
Endocrinology, Institures of Endocrinolgy and Clinical Surgery, Rome,
Eli-lilly, Italy.                                                                             Objective: To study the influence of multiparity, duration of lactation,
                                                                                              together with the post menopausal period on bone mineral density
Objective: Menopause is known to be a critic period for bone mineral                          Study method: A retrospective study to the bone mineral density
density (BMD). In order to evaluate the relationships between body                            measurement using Dual Energy X-ray Absorptiometry (DEXA) of
weight and BMD in peri-menopausal women, we have evaluated the                                1000 postmenopausal Egyptian women attending Women's Health
changes in total and segmentary BMD in a group of obese women (n=27                           Center, Nasser Institute Hospital, Cairo Egypt for measuring their bone
mean age: 48 yrs), and a group of women with surgically induced weight                        mineral density. The T score was performed to the bone density
loss (2 years after biliopancreatic diversion, n=12, mean age 47.5 yrs.), a                   assessment and the Z score was performed to exclude secondary causes.
procedure known to interfere with factors regulating a mineral                                Exclusion criteria to other causes are included in the history taking and
metabolism. Eighteen women (mean age 49 yrs.) were also studied as                            in the Lab. investigations.
controls.                                                                                     Results: 1000 postmenopausal women have been tested for the bone
Study Methods: The patients were studied by double emission X-ray,                            mineral density using DEXA. The age range was between 45 and 72
absoptiometry (DEXA).                                                                         years with the mean +/_ SD equals 55 6/12 years +/_ 4 3/12 years. The
Results                                                                                       parity range was from 0 to 9 deliveries with the mean of 4.3 +/_ 2.1, the
Table I summarizes the results. All data are in g/cm3 (mean±SD)                               lactation period ranged from 0 to 21 months with the mean of 7.4 +/_ 3.2
            BMI        BMD Head       BMD Arm       BMD Leg       BMD Trunk     BMD Total     SD. The bone mineral density in antero-posterior view of lumber
 Obese      41.2±6.5   2.191±0.357    0.944±0.161   1.174±0.154   1.094±0.229   1.181±0.139   vertebrae (L), femur neck, and ultradistal part (UD) of radius bone, was
 Post-BPD   29.2±8.0   2.285±0.168*   0.943±0.113   1.232±0.110   1.065±0.107   1.211±0.078   measured in grams/squared centimeter (g/cm2). The mean L 2-4 was
 Controls   28.9±4.2   2.017±0.327    0.868±0.155   1.166±0.158   1.039±0.174   1.149±0.138   0.983 g/cm2 +/_ 0.017 SD, femur neck was 0.989 g/cm2 +/_ 0.015 SD,
*p<0.05 versus control                                                                        and the UD radius was 0.438 g/cm2 +/_ 0.026 SD. The study revealed
Conclusions: These data do not show significant variation in BMD                              diminished bone mineral density with multiparity and with lactation but
between obese, post-biliopancreatic and control subjects in peri-                             with no statistical significance.
menopausal period. BPD doesn’t appear to be a risk factor for                                 Conclusion: Multiparity and the period of lactation have an influence on
osteoporosis in such group of patients. Further studies can elucidate                         the bone mineral density but with no statistical significance.
bone metabolic homeostasis in obese women after surgically induced
weight loss.
                                                                                              COMPARISON BETWEEN THE EFFECT OF HRT AND CA+VITD3
FC1.10.06                                                                                     ON SUBCUTANEOUS COLLAGEN.
PARATHYROID HORMONE 1-34 (HPTH 1-34) AND ESTROGEN                                             M. Valente, C. Dettori, N. Buscemi, L. Zichella, Institute of OB/GYN,
PRODUCE DRAMATIC BONE DENSITY INCREASES IN                                                    University of Rome “La Sapienza”, Rome, Italy
PLACEBO-CONTROLLED RANDOMIZED TRIAL                                                           Objectives: The aim of this prospective study was to evaluate the
C.D. Arnaud, E.B. Roe, S.D. Sanchez, G.A. del Puerto, E. Pierni, P                            reduction of subcutaneous collagen in postmenopausal osteoporosis and
Bachetti, C.F. Cann, Program in Osteoporosis and Bone Biology,                                possibilities of diagnosis and prevention.
University of California, San Francisco, CA, USA.                                             Study Methods: Hundred postmenopausal women were enrolled in our
                                                                                              outpatient Prevention of Postmenopausal Disease Clinic. An informed
Objectives: To determine the bone-building efficacy of daily, self-                           consent was obtained from all patients. We evaluated the subcutaneous
administered, subcutaneous hPTH 1-34 (400 IU/day) plus oral estrogen.                         collagen decrease using an ultrasound technique through Osteoson
                                                                                              DCIII. According to the major or minor collagen reduction, the women
                                                                                              were divided in two groups (Group A and B).
MONDAY, SEPTEMBER 4                                                                                                                                  33

Women who showed a major collagen reduction (Group A) were treated          completed evaluated and assigned a cause according to ICD-10.
by Ca+Vit D3 while the other (Group B) received oral HRT. Both              Heamrage and sepsis formed 37.6 and 35.4% of maternal deaths.
therapies have been administered once a day, for one year. After six        Hypertensive disorders of pregnancy including Eclampsia was the third
months there was a cross-over between the two different therapies.          cause of death and found 20%. 7% women died of liver disease,
Results: The collagen thickness has been evaluated at the sixth month       tuberclosis and heart disease.
and at the end of the study. In both groups there was an increase of        Conclusion: The three delays as shown by other studies were confirmed.
collagen thickness. All the oral HRT treated subjects showed during the     Maternal-health education specially focused on nutrition establishing a
six months a major increase than the other group, but not very              referral system with this target area has been started with the help of
significant.                                                                nurses and post-graduate trainee residents in collaboration with district
Conclusion: The follow-up, we performed 60 days after therapy               health officer and the ministry of health. Follow up study will be
discontinuity demonstrated that the effects of both therapies were          conducted on the same lines after two years of intervention.

FC1.11 MATERNAL MORTALITY 1                                                 THE EFFECT OF PARITY ON MATERNAL MORTALITY: A
                                                                            MALAYSIAN EXPERIENCE
FC1.11.01                                                                   Z. Shamsuddin (1), K. Shamsuddin (2)
MISOPROSTOL FOR PREVENTION OF POSTPARTUM                                    (1) Dept. OB/GYN, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
HEMORRHAGE: A RANDOMIZED CONTROLLED TRIAL                                   (2) Dept. of Community Health, Faculty of Medicine, University
D.V.Surbek, P.M.Fehr, I.Hoesli, W.Holzgreve. Dept. of OB/GYN,               Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
University Hospital, Schanzenstrasse 46, 4031 Basel, Switzerland
                                                                            Objectives: The aim of this study was to evaluate the effect of parity on
Objectives: Post partum hemorrhage (PPH) is the single most important       maternal death in Malaysia.
cause for maternal mortality in developing countries. Oxytocin,             Study Methods: All maternal deaths reported in 1995 and 1996 were
methylergometrine and prostaglandin E2 are effective for the prevention     analyzed with regards to their parity status in this retrospective analysis
or treatment of PPH, but not suitable for developing countries because of   of cases reported to the National Technical Committee For the
their galenic properties, administration route or costs. Misoprostol        Confidential Enquiries into Maternal Deaths in Malaysia. The number of
(uterotonic prostaglandin E1) can be administered orally and is stable      parity-specific live births were obtained from the Statistics Department
and inexpensive. We examined efficacy and undesired side effects of         and used as denominator to calculate the rates.
prophylactically administered Misoprostol in third stage of labor to        Results: Of 251 maternal deaths in 1995, 48 (19.1%) were nulliparous,
reduce postpartum blood loss.                                               153 (61%) parity 1-5 and 50 (19.9%) parity >5 (grandmultipara).
Study Methods: In this prospective, randomized double-blind trial, n=65     Similarly in 1996, of the 220 maternal deaths 50 (22.7%) were
parturitients received either 600mg Misoprostol (MP) or Placebo (P)         nulliparas, 128 (58.2%) parity 1-5 while 42 (19.1%) were grand
orally immediately after cord clamping at vaginal delivery. Exclusion       multiparas. Parity specific maternal mortality rate (MMR) for nulliparas
criteria included increased risk for PPH and cesarean section. Active       were 32.8/100,000 for 1995 and 24.4/100,000 for 1996. For paral-5, it
management of third stage of labor was routinely performed, though          was 44.9/100,000 for 1995 and 38.2/100,000 for 1996. The parity
additional oxytocin was administered solely if indicated. Postpartum        specific MMR were highest for grandmultiparas with 73.22/100,000 and
blood loss (primary outcome-parameter) was estimated and assessed by        69.5/100,000 for 1995 and 1996 respectively. Parity status also
measuring pre- and postpartum hemoglobin and hematocrit values.             influenced the cause of death; deaths in primigravidas in both years were
Results: Maternal age, parity, gestational age, duration of first and       largely from complications of PIH. Mothers who were Para 1-5 died
second stage of labor, birth weight, rate and grade of episiotomies and     from either PPH or obstetric pulmonary embolism while
vaginal/perineal tears were not different between the groups. Estimated     grandmultiparas mainly died from PPH.
blood loss (mean±SEM 345±19.5 vs. 417±25.9 mL, p=0.031), Hb-                Conclusion: Parity-specific rates showed a decline in all parity groups
difference (1.6±0.3 vs. 2.6±0.3 g%, p=0.015) and Hc-difference (4.5±0.9     for deaths in 1995 and 1996- and longer series may better show this
vs. 7.9±1.2%, p=0.014) were significantly smaller in the MP-group           change over time. Grandmultiparity is associated with the highest risk of
compared to the P-group. The rate of PPH (def.: blood loss ³500mL)          subsequent maternal deaths among mothers in Malaysia. Increasing
was smaller after MP than after P (7 vs. 15%, p=0.43), and fewer            parity may be associated with a dysfunctional uterus which tends to
subjects in the MP-group needed additional oxytocin (16 vs. 38%,            result in uterine atony and subsequent PPH.
p=0.047). With the exception of increased shivering after MP (22 vs.
3%, p=0.023), no significant differences were found concerning
unwarranted side effects.                                                   FC1.11.04
Conclusions: For the first time our study shows that oral MP for third      MORBIDITY AND MORTALITY IN PATIENTS DURING
stage of labor reduces postpartum blood loss in comparison to placebo.      PREGNANCY
MP has the potential to decrease the incidence of PPH.                      V. Elizalde, Hospital de Ginecología y Obstetricia del DIFEM, Toluca,
                                                                            Mexico. M. Arceo, Universidad Autónoma del Estado de México,
                                                                            Toluca, México. Ma. Montes, Hospital de Ginecología y Obstetricia del
FC1.11.02                                                                   DIFEM, Toluca, Mexico. O. Flores. Hospital de Ginecología y
COMPREHENSIVE MATERNAL HEALTH DATA OF ISLAMABAD                             Obstetricia del DIFEM, Toluca, Mexico.
G.Mahmud, T.Nakasa, A.Haq, S.Khan, Pakistan Institute of Medical            Objectives: To identify the causes of morbility and mortality in patients
Sciences, hno.35, st.63, f-10/3, Islamabad, Pakistan, 44000.                during pregnancy.
                                                                            Study Methods: We included 27140 patient from a Ginecology and
Objective: Under the MCH-jica project at P.I.M.S Islamabad this study       Obstetrics Hospital in Toluca, Mexico in the retrospective, transverse
was conducted. Pakistan has one of the highest maternal mortality at 340    and descriptive study.
(UNICEF-97) . National health survey report of pakistan 1998 shows a        Results: The group of age more affected was that of 20 to 29 years, with
mmr of 500. Four health surveys were conducted in the ICT(Islamabad-        the mean of 25 +/- 7 and a range of 11 to 48 years. The morbility that
capital-territory). House hold survey for Community data on 8000            was presented in this study allowed to identify the principal ten causes
households. Referal hospital data was from 7 tertiary care hospitals and    of morbility during pregnancy: in the first place the abortion and after in
health facility survey was collected. To propose and carry out              order of diminishing frequency as follows: acute fetal suffering, severe
interventions to improve maternal health indices.                           preeclampsia, preterm delivery, risk of preterm delivery, fetal death,
Study methods: Community survey was carried out by sisterhood               premature membrane’s break < 12 hours, mild preeclampsia, premature
method. Referral level hospital survey by two questioners using verbal      membrane’s break > of 12 hours and endometritis. The registered
autopsy of the attendant and the next of kin of the women dying.            mortality was of 20 patients; being the septic shock the factor of greater
Results: From the community survey by sisterhood method the mortality       frequency.
rate was 50080. The referral level hospital survey showed a mortality of    Conclusions: The morbility rate was of 21 for each 100 patients during
380. In the facility survey 61 deaths were reported and 44 could be         period of pregnancy. There wasn’t any group of specific age, being the
34                                                                                                                     MONDAY, SEPTEMBER 4

maternal death rate that of 7 of each 10 000 women who requested             FC1.11.07
pregnancy attention in our hospital.                                         MATERNAL MORTALITY: THE PERSISTENT SCARE: A REVIEW
                                                                             OF MATERNAL DEATHS AT THE PROVINCIAL GENERAL
                                                                             HOSPITAL NAKURU 1994-1998
FC1.11.05                                                                    E.A. Juma, F.N. Odongo, Provincial General Hospital, Nakuru, Kenya.
YAZD PROVINCE COMPARISON WITH OTHER CITIES OF IRAN                           Objectives: To evaluate the factors that led to maternal mortality over
M.A. Karimzadeh, Dept.OB/GYN. Shahid Sadughi Medical University.             the last 5 years at the Provincial General Hospital, Nakuru.
Mahdieh Cross, Madar Hospital, Yazd. Iran                                    Design: A retrospective study based on the data from the records office
R. Taheripanah. Dept. Reproductive Endocrinology. Avesina Research           at the Provincial General Hospital, Nakuru.
centre, Tehran, Iran                                                         Setting: Department of Obstetrics and Gynecology at the Rift Valley
P. Babazadeh. Dept. OB/GYN. Shahid Sadughi Medical University                Provincial General Hospital, Nakuru.
                                                                             Subjects: 109 deaths were evaluated. These were deaths where records
The aim of this study was evaluation of maternal mortality rate in Yazd      were available. These deaths occurred either during pregnancy or within
province compared with country (Iran) and determination of their             42 days of termination of pregnancy between January 1994 and
etiology.                                                                    December 1998.
Study methods: In order to measerment of maternal mortality rate ,this       Results: The average maternal mortality was 3.16/1000 live births. 28
retospective cross-sectional was done by reading the records of statistic    (26%) occurred in teenagers. Those aged 14-24 years contributed to 62
of health centers and dead mothers due to pregnancy and delivery             (58%) of deaths. Most deaths occurred in Nulliparous and primiparous
complications from 1988 to 1997.                                             patients 37 (34%). The commonest cause of death was hemorrhage and
Results: Maternal mortality rate was 15.5 per 100000 live birth in Yazd      ruptured uterus 48 (44%). Most deaths 58 (53%) occurred within 24
province versus 41.4 per 100000 live birth in country from 1992-1996.        hours of admission. Of these 36 (62%) came directly from home in labor
Direct maternal death was 76% and indirect causes consists of 26% of         or ill or where deliveries were being attempted by laypersons.
all maternal mortality rates. The most common causes of direct maternal      Conclusions: Most of the deaths evaluated were preventable. These
deaths include : hemorrhage (28%), eclampsia (20%), infection (12%),         deaths occurred due to delays in seeking proper medical care, poor
embolism (8%) and miscellaneous (8%).                                        medical care and lack of facilities. The major causes of death:
The most common causes of indirect MM includes hepatitis (16%) and           hemorrhage and ruptured uteri occurred mostly as a result of obstructed
heart diseae (8%).                                                           labor. With poor blood transfusion services and the risk of HIV, proper
Conclusions: In the Yazd province maternal mortality rate has the            management of these complications may call for alternatives to direct
smallest rate in Iran due to establishment new medical centers in their      transfusion. Referral systems need to be overhauled and referring health
cities and reduction dispatched patients due to gynecologists activites in   institutions should get properly staffed. Despite good antenatal clinic
the other small cities.                                                      attendance and availability of resources most patients still deliver or
                                                                             attempt to deliver at home due to poor knowledge and attitude towards
                                                                             safe motherhood.
F. Hussain (1), A.B. Bhuiyan (2), Y.A. Haque (3)                             FC1.11.08
(1) Dept. OB/GYN, Dhaka Medical College & Hospital, Dhaka,                   MATERNAL MORTALITY IN ECLAMPSIA -REASSURING
Bangledesh.                                                                  TRENDS FOR THE NEW MILLENNIUM
(2) House-42, Road-4A, Dhanmondi, Dhaka, Bangledesh.                         P.K. Shah, S. Rao, S.Dholakia, R. Punjabi, L.T.M.M.C. & L.T.M.G.
(3) H&N Section, UNICEF, Dhaka, Bangledesh.                                  Hospital, 121, Vithalwadi,3rd floor, Kalbadevi Road, Sion, Mumbai,
                                                                             Maharastra, India, 400002.
Objectives: The aim of the study was to ascertain the level, pattern and
contributing factors of maternal deaths in rural Bangladesh.                 Objectives: Mortality due to eclampsia remains one of the leading direct
Study Methods:                                                               causes of Maternal deaths in a developing country like India.The present
(1) Type of study: Descriptive study with a cross-sectional design.          study attempts to focus the changing trends in Maternal mortality in
(2) Study area: Gopalganj District.                                          cases of eclampsia at a 14,00 bedded tertiary referral teaching institute
(3) Study period: Between September 1997 to August 1998.                     over a span of twelve years.
(4) Sample size: 205 maternal deaths.                                        Study Methods : 365 cases of eclampsia out of 66,180 deliveries at our
(5) Data analysis: ANOVA and Chi-square test were used.                      hospital were categorised in 2 study groups:Group-A(1988-
Results: A total of 205 maternal deaths occurred from 1994 to 1997. At       1993)&Group-B(1994-1999).Various parameters including maternal
or above 35 years, maternal deaths increased as gravidity increased.         mortality were compared in each of the groups.
Teenager mothers had more deaths in first pregnancy than subsequent          Results : The incidence of eclampsia in group-A was 0.58% & in group-
pregnancies. Hemorrhage was the most common cause of death (34.6%)           B was 0.54%.Eclampsia was more common in primigravida in group-B
followed by eclampsia (33.7%). Eclampsia was more prominent in               (76.1%) compared to group-A (48.6%).88.6% in group-A& 72.6% in
patients who were <20 years and primigravides while hemorrhage was           group-B had received either no or inadequate antenatal care. 28.6%
the leading cause between 25-35 years and in multi-gravids (for age          patients in group-A & 83.1% patients in group-B delivered within 12
p=0.029, for gravidity p£0/001). 63.9% occurred in the postpartum            hours of onset of convulsions. 63.6% in group-A &50.3% in group-B
period and was due to hemorrhage (p=0.001). Only 23.9% patients              delivered vaginally. The Caesarean section rate was 48% in group-B
attended health facility. Families with conception about where and how       compared to 13.9% in group-A.Maternal mortality in group-A & group-
to reach health facility attended the facility (p=0.001). Husband was the    B respectively were 101.5 & 18.5 per one lac live births.
principal decision-maker for seeking care. Problem unrecognized              Conclusions : Adequate antenatal supervision,timely referral of
(45.1%) economic constraints (27.5%) and time constraints (9.9%) acted       eclamptic patients to tertiary institute, reducing the time interval
as barrier in seeking care. Those who reached health facility substandard    between the onset of convulsions & delivery, an earlier recourse to
care was observed in 82.9% cases and in 71.5% patients it was found          Caesarean section & routine administration of MgSO4 therapy would
that death could be avoided.                                                 collectively go a long way to achieve the best possible outcome in
Conclusions: The findings of the study support the view that underlying      eclampsia.
the medical causes of maternal death are a range of social, economic and
cultural factors that contribute to women’s health before, during and
after pregnancy.
MONDAY, SEPTEMBER 4                                                                                                                                 35

FC1.11.09                                                                  may be due to better quality oocytes generated in congenial follicular
MATERNAL MORTALITY IN SYLHET M.A.G. OSMAN I                                estrogen environment or favorable endometrial receptivity.
A. Khatun, Dept. OB/GYN, M.A.G. Osmani Medical College Hospital,
Sylhet, Bangladesh.                                                        FC1.12.02
                                                                           PERIOVULATORY SCORING OF ENDOMETRIUM FOR
Objectives: To determine the major causes responsible for the maternal     PREDICTION OF IMPLANTATION IN ART AND CLINICAL
mortality in our country and to formulate and suggest recommendations      EVALUATION OF USE OF VARIOUS DRUGS TO IMPROVE
for reducing the maternal mortality rate.                                  BLOOD FLOW & PREGNANCY RATES
Study Methods: The study analyzes all maternal death over a period of      J. Malhotra, N. Malhotra, J. Shah, P. Shah, V. Mathur, M. Shobhna, V.
five years from January 1988 to June 1992. 10,764 patients were            Sarika, A.B.Singh, Malhotra Test Tube Baby Centre, Agra, India.
included in the study.
Results: There were 243 deaths of post-partum women during the five-       ART has come to stay and is now within reach of the mass population
year period from January 1988 to June 1992. There were 10,764 live         even in developing countries. Today, there has been a great
births during the study period, giving incidence of maternal death of      improvement in drugs for stimulation, oocytes retrieval, state of the art
22.60 per 1000 live births. The most important causes of maternal          labs, culture media, ICSI and cryopreservation. This had led to good
mortality in our study are:                                                quality embryos. Implantation still eludes scientific basis and even on
a) Toxemia – 41.15%                      b) Hemorrhage – 16.04%            transfer of good embryos, the pregnancy rates and take-home baby rates
c) Obstructed Trauma – 13.16%            d) Infection – 7.80%              have not improved dramatically.
e) Abortion – 2.05%                      f) Other causes – 13.99%          Objective: With the improvement of color flow dynamics & studies of
Still today this figure is more or less the same in our country. The       endometrium, various scoring systems and gradings have been
current estimated M.M.R. is 4.2 (per 1000 live birth).                     developed to predict the receptive endometrium and to score an
Conclusion:                                                                endometrial biophysical profile.
Steps to reduce maternal mortality:                                        Study Methods: Based on these studies, we have tried to predict
(1) Improvement of economical conditions, literacy rate and                implantation in 92 prospective IVF cycle and 215 prospective IUI cycles
       nutritional status                                                  and 222 spontaneous non-induced non IUI cycles.
(2) Early registration of pregnancy                                        Results: Out initial results indicate that with good score, zone 4
(3) Provision to identify high risk cases                                  vascularization and no. of spiral arteries can predict implantation up to
(4) Family planning counseling                                             82.6% in ART cycles. We have further tried some auyurvedic non-
(5) Essential obstetric care                                               hormonal Indian medicine M2 Tone with proven estrogenic activity as an
                                                                           adjunct therapy to improve endometrial scores and overall results. We
                                                                           have also evaluated the use of aspirin, nitroderm pathes & B-complex
FC1.12 OVULATION INDUCTION                                                 and antioxidant drugs.
                                                                           Conclusion: Statistically significant improvement in pregnancy rates has
FC1.12.01                                                                  been found in the Indian herbal drug (M2 Tone) group and in aspirin
TREATMENT OF ANOVULATORY INFERTILITY WITH                                  group.
H. Konar (1), B.N. Chakravarty (2)                                         FC1.12.03
(1) Burdwan Medical College, Burdwan, West Bengal, India                   IS LUTEAL SUPPORT NECESSARY IN PREGNANCIES
(2) Institute of Reproductive Medicine, Calcutta, India                    FOLLOWING INFERTILITY EVALUATION ?
                                                                           Sucheta Jindal, Siya Sharma, Pratap Kumar. , Dept of Obst & Gynae,
Objective: The objective of the present investigation was to compare the   Kasturba Medical College, Manipal 576119
results of treatment of anovualtory infertility with clomiphene alone or
in combination with a single dose of gonadotropin.                         Objective: To compare the pregnancy outcome in women who received
Study Design: A total of 1,140 women below the age of 38 years were        luteal support following conception after superovulation with those
enrolled for the study. They were euthyroid, normoprolactinemic and        conceived spontaneously.
belonged to WHO gr.II anovulatory subjects.                                Study Methods: All 154 infertile cases who conceived were studied
Tubal patency was confirmed and husbands’ semen profiles were within       under three groups. In group I, 31 cases conceived spontaneously. After
normal range. Ovulatory status was ascertained by serial folliculometry    superovulation and insemination, in group II, 75 cases conceived using
and estimation of P4 between D21 and D23. Six hundred seventy-six          clomiphene citrate (CC) and in group III, 48 cases conceived using CC
women were treated with clomiphene citrate (CC), 100 mg per day            plus human menopausal gonadotropin. The post conception treatment,
starting on D3 and continuing through D7. Remaining 464 subjects were      luteal support, obstetric & neonatal outcome were evaluated.
treated in similar CC schedules but adding one ampoule of urinary FSH      Results: Nearly, 32% cases received luteal support in Gr I as compared
(75 IU) on D3 of the cycle. Unless and otherwise the women achieved        to 56% and 62% in Gr II & Gr III, respectively, but the early pregnancy
pregnancy, the treatment was continued for 6 consecutive cycles. All       wastage was higher in Gr I (26%) than in Gr II (12%) and Gr III (14%).
patients received luteal phase support with progesterone (Duphaston, 10    Term pregnancies were more in superovulation groups (67% Gr II,
mg daily) or hCG (2000 IU every alternate day) when USG evidence of        67.6% Gr III) in comparison to spontaneous group (56% Gr I).
ovulation (collapse of dominant follicle and appearance of fluid in        Threatened abortion, PIH, GDM, and APH were present in 22% (Gr I),
P.O.D. was visible.                                                        30% (Gr II) and 42% (Gr III) women. Low birth weight babies were
Results: In the CC group, 65.8% (445/676) of the women had evidence        born in 19% (Gr I), 39% (Gr II) and 37% (Gr III) patients.
of ovulation but only 6.6% (45/676) achieved pregnancy. Five women         Conclusion: If luteal support is given in conceptions following infertility
(11% of the pregnancies) had spontaneous abortion, and viable delivery     evaluation, the early pregnancy wastage is less and the incidence of term
rate was 5.8% (39/676). Of the remaining women, no follicular              pregnancies is more.
development was evident in 123 women (18.2%), while in 108 women
(16%) follicles developed, but did not rupture (LUF). In the CC/FSH
group, ovulation rate (64.2%, 298/464) was comparable to that of the       FC1.12.04
CC group. The incidence of LUF (20.7%, 96/464) and absence of              WHICH INDEX OF OVARIAN HEMODYNAMIC PARAMETERS IS
follicular development (15.1%, 70/464), likewise, did not differ           THE MOST OPTIMAL FOR PREDICTING OVULATION AFTER
significantly. The rates of pregnancy (19.5%, 91/464) and viable           HCG ADMINISTRATION?
delivery (18.9%, 87/464), however, were comparatively higher, while        T. Waseda, S. Miyazaki, Y. Watanabe, T. Kaneko, S. Makinoda, Dept.
the rate of miscarriage (3.3%, 4/91) was significantly lower.              OB/GYN, Kanazawa Medical University, Uchinada, 920-0293 Japan
Conclusion: For cost-effective ovulation induction, single dose
gonadotropin with clomiphene citrate is superior to clomiphene alone.      Objectives: The immediate increase of ovarian blood flow after hCG
The difference in the rates of establishment and wastage of pregnancy      administration has been reported in various animals. We have already
                                                                           reported that this phenomenon can be detected also in human. The aim
36                                                                                                                       MONDAY, SEPTEMBER 4

of the present study is to elucidate which index of color Doppler analysis   FC1.12.06
of ovarian artery is the most optimal for predicting ovulation.              GALACTORRHOEA AND ULTRASOUND BREAST FINDINGS
Study Methods: Under the informed consents, 35 patients who received         S. Plesinac, D. Ivanovic, A. Glisic, Institute of OB/GYN, Belgrade,
ovulation induction by Clomiphene citrate-hCG or hMG-hCG at                  Yugoslavia.
Kanazawa Medical University Hospital participated in this study. The
transvaginal color Doppler was used and the flow indexes of Vmax,            Objectives: The aim of the study was to determine hormonal levels and
Vmin, Vmean, PI, RI, Area, VMT and QT (Blood flow) of ovarian                the breast changes in patients with galactorrhoea.
artery were measured before and at 15, 30, 60, 120, 180 min after hCG        Study Methods: Fifty patients were observed for galactorrhoea. They
(10000IU) injection. The measurements were carried out 3 times at each       were divided in two groups: Group A 13 patients with normal prolactin
point by 3 staffs. Statistical analysis was carried out using Fisher’s       levels and Group B 37 patients with increased prolactin levels. Statistical
PLSD.                                                                        analysis was made by Fisher Testing.
Results: Ovulation was induced successfully in 31 cases. In these cases,     Results: Beside the galactorrhoea patients complained on amenorrhoea
all indexes except PI and RI showed increases after hCG injection.           12% of patients in group A and 66% in group B and mastalgia 23% in
Vmax showed a significant increase from 37.6 Å} 2.1 cm/sec                   group A and 54% in group B. Decreased levels of FSH, LH were noticed
(meanÅ}SEM) before hCG injection to 45.6 Å} 2.6 (P<0.05) at 15 min           in 23% of patients in group A and 64% in group B. Decreased levels of
and thereafter. Vmax at 180 min was 51.8 Å} 2.9 (P<0.0005). Although         Estradiol were in 15% of patients in group A and 37% in group B. The
other indexes except PI and RI showed significant increases, the Vmax        breast ultrasound findings were as follow: dysplastic changes group A
was easily measurable and SEM between staffs was the lowest among            37% group B 83%, benign breast tumors all 3 in group B (8.1%),
the indexes. In contrast, no significant changes in all flow indexes were    ductectasio 0% group A and 24% group B. Mammography was
observed in 4 cases, which have failed in ovulation induction.               performed in eight cases when PA smears of the breasts were group
Conclusions: These results demonstrate that Vmax is a useful marker for      three.
predicting ovulation after hCG administration and the measurement of         Conclusions: The breast secretion is not mandatory caused by
Vmax will be used widely to predict ovulation in the treatment of            hyperprolactinaemia. It can be a sign of dysplastic changes of the breast.
ovarian dysfunction.                                                         If there are increased prolactin levels begin breast tumors and mastalgia
                                                                             are more frequent. There were no carcinoma of the breast in our study.

UPDATE ON OVULATION AND FERTILITY MONITORING BY                              FC1.12.07
ASSAY                                                                        COURSE
A. Saporosi, E. Giacchi, M.C. Squintani, A. Merola, A. Mancini*,             T. A.Nazarenko, T. N.Lysaya, E. R.Durinyan, N.A. Zyryaeva, F.G.,
A. Cappella and J.B. Brown°.                                                 Djabrailova Research Center of Obstetrics, Gynecology and
Center for Study and Research on Natural Fertility Regulation,               Perinatology, Russia, Mosrow
*Department of Endocrinology, Catholic University of the Sacred
Hearth, Rome, Italy.                                                         Objectives : To analyse the clinical course of indused pregnancies in
°Department of Obstetrics and Gynecology, University of Melbourne,           patients with anovulatory infertility. Materials and metods
Australia.                                                                   585 pregnant women after ovulation induction with terms of gestation
                                                                             from 4 to 38 weeks was observed. 111 of them (18,9%) have multiple
Objectives: This study aims at comparing the information provided by         pregnancies (2-5 fetus), the average age of women was 32,6 years.
the cervical mucus symptoms according to the Billings Ovulation              Results : Complications of pregnancy in all women from early terms of
Method (BOM) and hormone urinary assays for monitoring the                   gestation were noted: miscarriage, undeveloping pregnancies in 1 term,
menstrual cycle in all conditions of ovarian activity.                       premature labor, toxicosis and gestosis. On the base of analysis of 100
Methods: 40 women, BOM users, aged 22-48 years, were studied for 90          induced pregnacies with pregnancy loss in 1 tremester the most
cycles, i.e.7.5 women years of experience: 11 had irregular cycles; 16       frequently risk factors were determined: The women age more then 36
wanted to avoid pregnancy and 10 were sub-fertile couples. They              years -22% OHSS 3-4 degree -18% Multiply pregnancy * 4% Previous
collected a timed specimen of urine daily. 1802 assays were performed        preparation for pregnancy lack * 22% Hyperandrogeny * 34% The
using the Brown’s Ovarian Monitor (OM) (St. Michael NFP Serv. Pty            normalisation of hormonal parameters (high sex steroid level in 5-10
Ltd. Melbourne) which uses a “homogeneous EIA” to measure oestrone           tims more then normal) only after 12-15 weeks of gestation was noted.
glucuronide (E1G) or pregnandiol glucuronide (PdG). All values are           In women with initial suprarenal hyperandrogeny the corrective therapy
expressed respectively in nmol/24 hrs and mmol/24 hrs (mean+/-SEM).          with glucocorticoid was conducted.
Results: All cycles resulted ovulatory. 84.4% cycles presented an            Conclusions : Induced pregnancies are assosiated with high risk of
identifiable E1G baseline (133.25 nmol/24hrs+/-3.88 SEM) (n=76),             pregnancy: miscarriage and undeveloping pregnancies in 1 term. The
corresponding to the Basic Infertile Pattern (BIP) by the BOM, i.e. the      disturbancies of embriogenesis and placentation are caused by
phase of pre-ovulatory ovarian inactivity. The first E1G rise (increment     nonphysiological hormon parameters during 1 term of gestation, which
from baseline = 144.76 nmol/24hrs+/- 13.08 SEM) occurred generally           request adequate medicament correction
on the same day of the first change in mucus symptom from BIP,
indicating the beginning of the fertile phase. Maximum mucus
production closely correlated with the pre-ovulatory E1G peak (289.36        FC1.12.08
nmol/24 hrs+/-14.15 SEM). The day of maximum fertility by the BOM            THE ADVANTAGES OF OVULATION INDUCTION USING
correlated within 24 hrs with the day of ovulation detected by the           RECOMBINANT FSG IN COMPARISON WITH HUMAN
hormone assays (77.8% cycles). The OM allowed the monitoring of the          MENOPAUSAL GONADOTROPIN TREATMENT OF
whole luteal phase. The value of the mid-luteal PdG was 16.56 mmol/24        ANOVULATORY INFERTILITY.
hrs+/-0.85 SEM showing an overall adequate luteal function.                  T.A. Nazarenko, E.R. Durinian, T.N. Chechurova, Research Center of
Conclusions: The BOM is based on the identification of the cervical          Obstetrics, Gynecology and Perinatology, Moscow, Russia.
mucus symptom that reflects the individual hormonal ovarian pattern
during the menstrual cycle. The OM is an accredited laboratory               Objectives : To compare the results of ovulation induction in women
instrument that confirms the scientific basis of the modern methods of       with anovulatory infertility with the use of r-FSH and hMG.
Natural Family Planning. Both BOM and OM offer the advantage of              Study Methods : Puregon was used for 24 cycles of ovulation induction
reflecting the increase in the knowledge of human reproduction.              in 20 PCOS women.The average age of them was 28,3 years, lasting of
                                                                             infertility - 3,7 years, average level of LH - 12,8 IU/l; FSH - 5,0 IU/l;
                                                                             estradiol - 158 pmol/l; testosteron - 2,6 nmol/l. Humegon was used for
                                                                             35 cycles of ovulation induction in 30 women with PCOS. The average
                                                                             age was 27,9 years, lasting of infertility - 3,4 years, average level of LH
                                                                             - 12,4 IU/l; FSH - 5,2 IU/l; estradiol - 169 pmol/l; testosteron - 2,5
MONDAY, SEPTEMBER 4                                                                                                                                  37

Results : The efficacy of ovulation induction with puregon was 45% of        selection of patients that should be scheduled for an operative
pregnancy per woman and 37,5 % per cycle of stimulation, that can be         hysteroscopy.
compared with the efficacy of hMG treatment - 43,3% per women and
37,1% per cycle. The frequency of OHSS developing occured in 10% of
cases with puregon and 33,3% witn hMG.We noted no cases of                   FC1.13.02
undeveloping and multiple pregnancy with puregon. The rate of                THE IMPACT OF INTRODUCING TRANSVAGINAL
misscarriage and multiple pregnancy with hMG was 10%. The                    SONOGRAPHY ± PIPELLE ENDOMETRIAL BIOPSY ON THE
folliculogenesis induced by puregon was closer to parameters of              MANAGEMENT OF MENSTRUAL DISORDERS
spontaneous menstrual cycle - in 25% of women 1 periovulatory follicle,      K. Reddy, C. Absi, N. Amso, Dept. OB/GYN, University Hospital of
spontaneous ovulation and average peak of estradiol (500-600 pmol/l)         Wales, Cardiff, U.K.
were noted.
Conclusions : Ovulation induction using r-FSH has more advantages            Objectives: The aims were to determine Transvaginal scanning (TVS)
than hMG, such as reduced rate of complications : OHSS, multiple             findings in women with menstrual disorders, the need for further
pregnancy and misscarriages. This happens because of the better              investigations and cost implications/savings of this practice.
physiologic parameters for the follicular development. It may increase       Study Methods: Over 15 months 239 women were referred to a TVS
the efficacy and safety of infertility treatment.                            gynae-1-stop clinic. Data on 167 women with menstrual disorders
                                                                             (menorrhagia±pelvic pain=89, inter-menstrual bleeding=34 and post-
                                                                             menopausal bleeding=44) were collected prospectively and analyzed.
FC1.12.09                                                                    Pipelle biopsy or hysteroscopy after TVS were regarded as intervetional
URINARY FSH HAS STILL A SIGNIFICANT ROLE FOR                                 procedures.
OVULATION INDUCTION IN INFERTILE COUPLES.                                    Results: In the menorrhagia ± pelvic pain group, 56 women had normal
P.Fatima, D.Rahman, L.Shamsuddin, M.M.Hossain, Dept. Gynae,                  pelvis of whom 7 required pipelle sampling, 32 women had fibroids, 1
Bangabandhu, Sheikh Mujib Medical University, Dhaka, Bangladesh.             required hysteroscopy for possible polyp. Overall, the diagnostic
                                                                             intervention rate was 9%.
Objectives : To observe the efficacy of recombinant FSH and urinary          In the true postmenopausal bleed (PMB) group, 15 patients needed
FSH in ovulation induction.                                                  diagnostic hysteroscopy, 10 required pipelle sampling, 2 had laparotomy
Study Methods : A prospective random sampling was done from 938              for ovarian masses and 2 did not required any intervention. Additional
patients undergoing ovulation induction in an infertility clinic in Dhaka,   15 women required operative hysteroscopy resulting in a diagnostic
Bangladesh during the period from January 1997 to December 1999. 48          intervention rate of 57%.
patients were selected for ovulation induction by Inj. Metrodin 48           Conclusions: The majority of scans in premenopausal women with
patients by Inj.Puregon in the first ovulation induction cycle. Ovulation    menorrhagia were normal. The higher intervetion rate compared with the
monitoring was done by transvaginal sonography only.                         menorrhagia group (57% vs 9%) was necessary to exclude malignancy.
Results : Out of 938 patients, 48 were selected for induction by Puregon     However 40% were pipelle biopsies carried out in the clinic. The cost
and 48 by Metrodin. Primary infertility comprised 47.9% and 62.5% of         implications were most obvious in the premenopausal group and it could
the patients undergoing ovulation induction by Puregon and Metrodin          be argued that in the PMB group we had avoided 29 diagnostic
respectively. 10.4% of the patients in Puregon cycle and 27% in              hysteroscopies!
Metrodin cycle conceived (at 5% level of significance, the p value is
<0.05). Mean ampoules of Puregon(50iu) and Metrodin(75iu) used were
6.9+_4.3 and 5.9+_ 2.6 respectively. In Puregon cycles, there was no         FC1.13.03
abortion and in patients receiving Metrodin, abortion was in 6.3% cases.     TRANSVAGINAL ULTRASOUND SCANNNING IN A
In both the groups anovulatory cycles comprised about 50% of the             GYNECOLOGY-ONE STOP CLINIC. DOES IT HAVE A ROLE?
indications for ovulation induction followed by male factor, idiopathic,     N. Amso, K. Reddy, C. Absi, Dept. OB/GYN, University Hospital of
combined and uterine factor.                                                 Wales, Cardiff, UK
Conclusion : Although fetal loss is more, urinary FSH has still
significant role in patients undergoing ovulation induction.                 Objectives: The aims of this study were to (1) evaluate the impact of
                                                                             transvaginal ultrasound (TVS) findings on clinical management and
                                                                             initiate appropriate action in one visit and (2) to determine the
FC1.13 ULTRASOUND IN GYNECOLOGY                                              appropriateness of our selected gynecological referral categories for the
                                                                             concept of this clinic.
FC1.13.01                                                                    Study Methods: 239 women were referred to this clinic between June
INTEREST OF HYSTEROSONOGRAPHY IN THE PREOPERATIVE                            1998 and August 1999. We analyzed the prospective data of 226 women
MANAGEMENT OF BENIGN UTERINE LESIONS                                         who met the referral criteria. The indications for referral were menstrual
JP. Bernard, S. Camatte, E. Rizk, I.Nahzah, F. Lécuru, R. Taurelle,          disorders, pelvic pain, suspected pelvic pathology, recurrent miscarriage
Service Gynécologie, Hôpital G Pompidou, Paris, France.                      and secondary infertility. The age group raged from 20-87 years.
                                                                             Results: In was shown that a definitive diagnosis was obtained and a
Objectives: To assess the value of hysterosonography (HS) in the             management plan formulated at the first visit in 197/226 (87.16%_
decision making of therapeutic options for benign intrauterine lesions.      women. TVS findings were inconclusive in 29/226 (12.83%) women
Study Methods: Patients scheduled for a surgical treatment because of        and further investigations were needed . Only 30/226 (13.2%) needed
abnormal bleeding were prospectively enrolled in a study conducted           inpatient hysteroscopy for both therapeutic and diagnostic reasons and
between January 1st 1996 and December 31st 1997. HS was used to              10/226 (4.4%) needed a diagnostic laparoscopy. The acceptance of TVS
establish further surgical management (hysterectomy or hysteroscopy).        was evaluated in a subset of patients. All women attending the clinic
The end point of the study was to compare the surgical option ultimately     were satisfied with the procedure.
carried out, with one decided after HS. Similarly, pathological results      Conclusions: Our study demonstrates the effectiveness of TVS to arrive
were juxtaposed to HS diagnosis. Statistical analysis used non-              at a diagnosis and initiate appropriate treatment for the majority of this
parametric and correlation tests.                                            group of women during a single outpatient visit. It represents a major
Results: 233 patients were included in the study, 39,5% of them were         development for patients and the health service as it has the potential in
postmenopausal. HS was effective in the choice of the best surgical way,     reducing unnecessary interventions.
because no hysterectomy has been required when an operative
hysteroscopy was indicated on HS data. Similarly, only one patient
treated by hysterectomy (5.8%) could have been treated by a more             FC1.13.04
conservative approach. HS correlated well with surgery for the location      ULTRASOUND DIAGNOSIS OF ENDOMETRIAL POLYPS
and size of intrauterine lesions (p<0.001). HS was accurate in the           A. Jakab Jr., B. Juhász, G. Bacskó, T. Major, Z. Tóth, Dept. OB/GYN,
diagnosis of polyps and submucous myomas (sensitivity 85.7%,                 University Medical School of Debrecen, Debrecen, Hungary.
specificity 95,4%).
Conclusions: HS appears as an interesting tool for pre-operative             Objectives: To investigate the clinical significance and the power of
assessment of benign intrauterine pathologies. It should be used in the      ultrasound imaging techniques in the diagnosis of endometrial polyps.
38                                                                                                                       MONDAY, SEPTEMBER 4

Study Methods: 114 women having endometrial polyps were included in            or hysteroscopic surgery. The findings were correlated with the
this retrospective study. All of them had operative hysteroscopy. Clinical     histopathology results.
and ultrasound data were evaluated to investigate the risk factors and the     Results : Mean age was 46.3 yrs ( 25-72 ). After SIS 23 had symmetrical
sensitivity of gray scale, color and power Doppler imaging in the              endometrium of various thickness, 35 (60%) had focal lesions , 23
detection of polyps. Transvaginal ultrasound used were Ultramark 4 (5          (39,6%) polypoid structures, 12 (20,6%) submucous or intramural
MHz) and ATL-3000 HDI (5-9 MHz, Bothell, Washington).                          leiomyomas and 1 (1,7%) asymmetrical endometrial thickening. 19
Results: Mean age of patients was 51.5 (21-79), 81.6% of the over 40,          (33%) patients were treated with no intervention, 20 (34.5%) with D&C
51% with eu- or amenorrhea. Only 56 women had abnormal bleeding,               only,10 (17.2%) with hysteroscopy. 8 (13.7%) hysterectomies were
21% of them underwent D&C previously. In the asymtomatic group                 performed,2 (3.5%) after failed hysteroscopic resection, and 2 (3.5%)
21% had infertility problems and 10% took tamoxifen. The sensitivity of        after D&C followed by hysterectomy. Symmetrical endometrial
gray scale ultrasound for the presence of polyp was 0.65. submucosal           thickness cannot exclude the presence of small polyps (2/6 cases).
fibroid was misdiagnosed in 10%, only the thick endometrium was                Asymmetrically thickened endometrium and polypoid structures were
revealed in 17% and 8% was false negative. Using color imaging of the          associated with focal lesions in 8/15 cases (53.3%),and endometrial
polyp central feeding vessels the sensitivity increased to 0.89, enhanced      hyperplasia in 7/15 (46.6%). Submucous leiomyomas were diagnosed
further to 0.92 by power Doppler. This way only one polyp was                  succesfully in all but one case with a polyp. One case of endometrial
misdiagnosed as fibroid, one as thick endometrium and there was no             cancer was diagnosed, associated with a submucous leiomyoma after a
false negative.                                                                negative D&C. For focal lesions the sensitivity, specificity and PPV of
Conclusions: Endometrial polyps are frequently present in infertile and        SIS was 0.55, 0.69 and 0.38 respectively. For submucous leiomyomas
tamoxifen taking women and women with recurrent abnormal bleeding.             the sensitivity, specificity, and PPV was 0.92, 0.95 and 0.92
Transvaginal color and even power Doppler imaging of the feeding               respectively.
vessels has significant advantage over grey scale imaging in the               Results : SIS is a simple and efficient method to diagnose endometrial
detection of polyps. The use of them is recommended in high-risk               pathology when there is no access to hysteroscopy .Hyperplasia as well
patients.                                                                      as polyps can cause focal endometrial thickness.

FC1.13.05                                                                      FC1.13.07
WITH POSTOPERATIVE ASSESSMENT                                                  M. Guida, N. Santangelo, G. Acunzo, M. Pellicano, D. Cirillo, C. Nappi.
J. Suzin, G. Surkont, W. Tyli_ski. Inst. OB/GYN, Medical Academy-              Dept. OB/GYN (Director: Prof. Carmine Nappi) University of Naples
University, Lód_, Poland.                                                      “Federico II”, Naples, Italy.

Objective: To compare preoperatively the diagnostic abilities of               Objectives: To compare the sensibility, the specificity, the diagnostic
transvaginal sonography (TVS), saline infusion sonography (SIS) and 3-         accuracy, and the tolerability of USG-TV and hysteroscopy in the
D imaging for the evaluation of the cavity of leimyotic uterus.                evaluation of postmenopausal abnormal uterine bleeding.
Material and methods: Open, prospective study was conducted in The             Study Methods: One hundred and ten postmenopausal women (age
Gynaecologic clinic. 27 women with uterine leimyomas referred to the           range 47-81 years), with clinical evidence of abnormal uterine bleeding,
Unit for hysterectomy were analysed. TVS (Hitachi EUB-515), SIS                were recruited from the gynaecological outpatient department of the
(Goldstein catheter) and 3-D imagining (view Point computer program            University “Federico II” of Naples, Italy. The exclusion criteria were
were performed before the operation. Diagnosis was compared with               outstanding HRT and pathologic Pap-test. All the women underwent an
postoperative histopatologic assessment.                                       USG-TV utilizing a 5 MHz vaginal sound Toshiba 240A sonography
Results: In 11 cases during TVS we had problems with good                      and, later, a diagnostic hysteroscopy with Hamou II hysteroscope
visualisation of uterine cavity. In these situations SIS was very useful: in   (diameter 5mm and 30° optics) and an endometrial biopsy. Sonographic
7 women normal endometrium, in 2 – endometrial polyps, in 1 –                  patterns were then compared with hysteroscopic findings and proved
endometrial huyperplasia were detected and confirmed later. In 1 case          with the histological results. After each proceeding, each patient
focal lesion diagnosed as endometrial polyp (SIS) was found to be              answered about her subjective assessment of pain, identifying a score
submucous leiomyoma. In this case 3-D imaging was helpful to establish         from 1 to 4 (1=minimal pain; 2=tolerable pain; 3=severe pain;
right diagnosis.                                                               4=intolerable pain.).
In 16 patients during TVS we detected normal endometrium. This was             Results: USG-TV and hysteroscopy showed, respectively, a sensibility
confirmed during SIS (in 11 cases) and 3-D (16 women); SIS showed              of 90% and 96%; a specificity of 88% and 94%; a positive predictive
normal endometrium and submucous myomas in 2 cases, in 1 woman                 value of 86% and 92%; a negative predictive value of 92% and 96%,
SIS showed uterine cavity in another place of the uterus (confirmed            and a diagnostic accuracy of 89% and 94%. The pain score was
postoperatively). We noted 7 % failure (2 cases) to perform SIS because        significantly lower for the USG-TV in comparison with hysteroscopy
of cervical stenosis.                                                          (1.4±0.5 versus 2.1±0.8), anyway, most patients subjected to diagnostic
Conclusions: Saline infusion sonography (SIS) is very sensitive method         hysteroscopy (88%) reported a tolerable pain.
to visualize the uterine cavity of the leiomyotic uterus. 3-D imaging may      Conclusions: Hysteroscopy can exclude and distinguish most
be helpful to determine endometrial polyp and submucous leiomyoma              endometrial pathologies and can be proposed as best practice in the
during SIS.                                                                    evaluation of patients with abnormal uterine bleeding.

FC1.13.06                                                                      FC1.13.08
OF ENDOMETRIAL PATHOLOGY                                                       OF POSTMENOPAUSAL WOMEN WITH AND WITHOUT
A.Papanicolaou, I.Prapas, G. Makedos, C.Farmakis, G.Vlassis, Aristotle         ENDOMETRIAL CANCER
University of Thessaloniki, 1 Agelaki str., Thessaloniki, Greece, 54621.       C.C.R.Bortoletto, W.J.Gonçalves, M.P.R.Caramuru, E.C.Baracat,
                                                                               G.R.Lima, Federal University of São Paulo, Rua Dom José Antônio dos
Objectives : The aim of this study is to report our experience in the use      Reis, 86, São Paulo, Brazil, 04672-030.
of sonohysterography with normal saline (SIS) for the diagnosis and
treatment of abnormal uterine bleeding.                                        Objective: To evaluate endometrial thickness and uterine arterial flow
Study methods : Prospective study of 58 patients with abnormal uterine         measurement (resistance index-RI and pulsatility index-PI) as predictors
bleeding or asymptomatic menopausal with endometrial thickness > 7             of endometrial cancer.
mm. Patients were treated incorporating SIS according to the protocol          Study methods: 45 postmenopausal women (31 with genital bleeding),
described by Goldstein et al (Am J Ob. Gyn 1997; 177; 102-8). Based on         aged 42-78, was submitted to transvaginal ultrasonography (TVUS) for
the findings of SIS, patients were treated with D&C and/or hysterectomy        measurement of endometrial echo thickness, followed by color Doppler
                                                                               of intramyometrial part of uterine artery. The RI and PI were obtained.
MONDAY, SEPTEMBER 4                                                                                                                                   39

Endometrial biopsies were performed and patients were divided into          Study Methods: Among a target population of 110 502 women (holders
three groups: I (N=14) with atrophy; II (N=15) with polyp, proliferative    of a sanitary health cards), distributed through 15 Health Centres on the
and typical hyperplasia; III (N=16) with adenocarcinoma.                    Island of Tenerife, a sample size of 466 women in quinquennial groups
Results: To detect adenocarcinoma, when the endometrial echo was less       (age 18-85) has been calculated in order to reach an estimation of
than 8mm, the TVUS had a sensibility of 100%; specificity of 55,2%;         prevalence by types of incontinence, with an accuracy of about 7%. The
positive predictive value (PPV) of 55,2%; negative predictive value         Spanish version of the King’s Health Questionnaire interview was used
(NPV) of 110%. When RI was < or = 0,60 the sensibility for                  to obtain the impact of incontinence on the QL.
endometrial cancer was 81,3%; specificity: 93,1%; PPV: 86,7%; NPV:          Results: The prevalence of the stress incontinence (SI) is of 52.1%, 38%
90%. When PI was < or = 1,00 the sensibility for endometrial cancer         of the urge incontinence (UI) and 29% show mixed symptoms. The SI is
was 87,5%; specificity: 89,6%; PPV: 82,3%; NPV: 92,9%.                      perceived as of maximum level (A LOT) in 9.9% and of 8.4% in those
Conclusions: TVUS had a very high sensibility for the detection of          of UI and both, are connected to frequency, urgency, nocturia and
endometrial cancer, but the specificity remained low. The use of TVUS       enuresis (p<0.000). Among the SI patients, 76.1% are post-menopause
associated with color Doppler reduced the number of unnecessary             and their peak age lies between 60 and 70 years of age. The 92.3% who
curettages, mainly when the cause of postmenopausal vaginal bleeding        suffer most from the UI are post-menopause and are older than 80 years
was atrophic endometrium.                                                   of age (p<0.000). There is no significant difference in the percentage of
                                                                            nil parity (15%). The women who have urinary incontinence feel that
                                                                            their health state is worse and that their urinary problems affect their
FC1.13.09                                                                   lives (p<0.000). The 18 items on the questionnaire which measure QL
ENDOMETRIAL STROMAL SARCOMA: CAN IT BE                                      are affected in distinctive levels when there is incontinence and the
DIFFERENTATED FROM ENDOMETRIAL HYPERPLASIA WITH                             women acquire habits such as wearing sanitary napkins, drink less
COLOR DOPPLER ULTRASONOGRAPHY?                                              liquids and have to change their underwear with frequency (p<0.001).
S. Janovic Raznatovic, A. Jurisic, L. Tasic, M. Vasiljevic, N. Antic, D.    Conclusions: The urinary incontinence has a high prevalence in women,
Popovic Skokljev, Z. Dinic, L. J. Dimitrijevic, S. Dragojevic, Clinic of    independently of the type and the severity, it is associated itself to other
OB/GYN, Narodni Front, Belgrade, Serbia, Yugoslavia.                        urinary symptoms and produces an impact on the quality of life.

Objectives: The aim of this study was to evaluate if color and pulsed
Doppler ultrasonographic characteristic of uterine and intratumoral         FC1.14.02
(endometrial) blood flow analysis could differentiate high-grade            TOLTERODINE IS EFFECTIVE AND WELL-TOLERATED
endometrial stromal sarcome (ESS) from endometrial hyperplasia (EH).        DURING LONG-TERM USE IN PATIENTS WITH OVERACTIVE
Study Methods: The study involved 39 patients (9 with high grade            BLADDER
endometrial stromal sarcoma and 30 with endometrial hyperplasia) who        H.P. Drutz, Dept. OB/GYN, Mount Sinai Hospital, University of
were examined with trasvaginal color and pulsed Doppler sonography          Toronto, Toronto, Ontario, Canada.
before the surgical treatment. Pourcelot resistance index (Ri), systolic
peak velocity (Vmax) and diastolic velocity (Vmin) were measured in         Objectives: Tolterodine is an antimuscarinic agent specifically
uterine arteries and endometrial vessels. Endometrial thickness and         developed for the treatment of overactive bladder (OAB), a chronic
depth of tumor invasion were also examined. Analysis of variance was        condition requiring long-term therapy to maintain symptom relief.
used to test the significance among the groups.                             Results of open-label extension studies investigating the long-term
Results: There is no significant differences including endometrial          efficacy/safety of tolterodine 2 mg twice daily (BID) are presented for a
thickness between groups. Myometrial invasion detected by ultrasound        cohort of patients who entered a second year of treatment.
was greater than 50% in all cases of ESS. Parameters representing           Study Methods: 707 of 1106 patients (64%) who had completed double-
uterine arteries blood flow did not show statistical significance between   blind, placebo-controlled, randomized studies of 2-12 weeks duration
mentioned groups. Endometrial blood flow analysis showed a                  and continued open-label treatment for up to 12 months entered a second
significantly lower resistance index in the group with ESS, than in         year of open-label treatment. Efficacy (change in micturitions and urge
patients with EH.                                                           continence episodes/24hr) was determined at baseline ad after 12, 18 and
Conclusions: Evaluation of endometrial vascular using transvaginal          24 months’ treatment. Safety was assessed from spontaneously reported
color Doppler ultrasonography may allow differentiation of high-grade       adverse events (AEs), withdrawals from treatment and measurement of
endometrial stromal sarcoma from endometrial hyperplasia. It could be       vital signs and routine laboratory analysis.
useful for the preoperative prediction regarding histological grade and     Results: 567 of 707 patients (80%) starting a second year of treatment
depth of myometrial invasion and eventually the presence of lymph node      completed the full year. Significant (p<0.05) decreases were noted for
metastasis. So, we believe that pelvic lymphadenectomy should be done       the micturition and incontinence variables and all timepoints and
if the lowest Ri value of endometrial blood flow is 0.35 or lower.          efficacy was maintained throughout treatment (see table).

FC1.14    URINARY INCONTINENCE: GENERAL FEATURES                            _                           Micturitions/24h       Urge incontinence
          AND MEDICAL MANAGEMENT                                                                                               episodes/24h______
                                                                            Baseline                    9.9                    2.4
FC1.14.01                                                                   12 months                   -21%                   -77%
URINARY INCONTINENCE AMONG WOMEN IN THE CANARY                              18 months                   -20%                   -75%
ISLANDS. PRELIMINARY INFORMATION                                            24 months                   -22%                   81%_____________
M.A. Pascual Amoros (1a), O.Y. Marco (1a), M.J. Rodríguez (1b), A.I.        Conclusions: Dry mouth was the most commonly reported AE during
Méndez (1c), A.I. Padilla (1a), F. Díez (1d), A. Jimenez (1b), A. Monga     the long-term treatment period (36% and 19% of patients in years 1 and
(2), J. Parache (1a)                                                        2, respectively). During the second year of treatment, a total of 46
(1) (a) Dept. OB/GYN, University Hospital Canaries, Canary Islands,         patients (6.5%) withdrew because of adverse events, of which only 8
       Spain.                                                               (1.1%) were as a result of dry mouth. There were no clinically relevant
       (b) Dept. Research Unit, University Hospital Canaries, Canary        changes in vital signs or laboratory parameters.
       Islands, Spain.
       (c) Nursing Dept., University Hospital Canaries, Canary Islands,
       Spain.                                                               FC1.14.03
       (d) Primary Care, University Hospital Canaries, Canary Islands,      PREGNANCY AND CHILDBIRTH – WHAT IMPACT DO THEY
       Spain.                                                               HAVE ON THE BLADDER FUNCTION?
(2) Princess Ann Hospital, Southampton, UK.                                 A. Al-Shibly, M. Maaita, M.M. Dabobi, H. Malkawi, Dept. OB/GYN,
                                                                            King Hussein Medical Centre, Amman-Jordan.
Objectives: To obtain the prevalence of urinary incontinence and its
impact on the quality of life (QL) among adult women in the Canary          Objectives: The aim of the study is to investigate the effects of
Islands.                                                                    pregnancy and delivery on bladder function to relate this to functional
40                                                                                                                              MONDAY, SEPTEMBER 4

symptoms, and to identify potential etiological factors for bladder           Bladder      Mild GSI   Moderate         Severe    Detrusor      Sensory        Normal
dysfunction noted after delivery.                                             neck                    GSI              GSI       Instability   Urgency
Methods: 572 nulliparous women beyond 34 weeks gestation were                 Open         46         119              337       152           8              74
recruited from the antenatal clinic and completed a urinary and bowel                      (25%)      (33%)            (57%)     (27%)         (7%)           (11%)
questionnaires about symptoms before and during pregnancy. The                Closed       136        241              288       406           110            636
women underwent subtracted provoked cystometry while erect and                             (75%)      (67%)            (43%)     (73%)         (93%)          (89%)
supine. Three months postnatally the investigations and questionnaires        Conclusions: An open bladder neck is not diagnostic of GSI but is
were repeated.
                                                                              associated with increasing severity of GSI. It is not associated with
Results: In all, 212 women returned from postnatal investigations, stress     urgency as a minority of women with sensory urgency were found to
incontinence before, during, and after pregnancy was reported by 4.5%,
                                                                              have an open bladder neck. Imaging the bladder neck at rest does not
45.1% and 19.4% respectively. The incidence of detrusor instability and       appear to be a useful aid to diagnosis.
genuine stress incontinence was 9.3% and 8.3% in pregnancy and 5.1%
and 6.5% after delivery. The reported postnatal symptoms of stress
incontinence was reported with a longer duration of an active second
stage of labor. Urodynamic variables were not significantly different         ONCE-DAILY ADMINISTRATION OF EXTENDED-RELEASE
between the normal vaginal delivery, instrumental delivery and cesarean
                                                                              TOLTERODINE IS EFFECTIVE AND WELL-TOLERATED IN
section groups. The reported symptoms did not correlate with                  PATIENTS WITH OVERACTIVE BLADDER
urodynamic diagnosis.
                                                                              S.E. Swift, Dept. OB/GYN, Medical University of South Carolina,
Conclusions: Objective and subjective urinary dysfunction is common in        Charleston, Couth Caroline, USA.
pregnancy and after delivery. An increased duration of active second
stage of labor is related to postnatal stress incontinence. Urodynamic        Objectives: To determine the efficacy, tolerability and safety of a new
variables and diagnosis were unaffected by mode delivery.
                                                                              extended-release (ER) formulation of tolterodine for once-daily (OD)
                                                                              treatment of overactive bladder.
                                                                              Study Methods: This was a randomized, double-blind, placebo-
FC1.14.04                                                                     controlled multicenter trial involving 1529 subjects (81% female).
                                                                              Subjects were randomized to receive one of three treatments: tolterodine
COLPOSUSPENSION                                                               ER 4 mg OD, tolterodine immediate-release (IR) 2 mg twice daily
Huvar, I.,Dvorakova, M., Podalova, S., Huvarova, OB/GYN, University
                                                                              (BID), or placebo. Both treatment-naïve patients and patients previously
Hospital Brno-Bohunice, Jihlavskß 20, 639 00 Brno, Czech Rep.                 treated for overactive bladder were enrolled. Patients were treated for 12
                                                                              weeks. Efficacy was assessed primarily with patient micturition diaries.
Objectives : The aim of this study was to investigate, how much the           Tolerability and safety was determined through adverse event reports.
successful anti- incontinence surgery can change the quality of life of the
                                                                              Between-group comparisons were made using analysis of variance.
subjects.                                                                     Results: Both tolterodine ER 4 mg OD and tolterodine IR 2 mg BID
Study Methods : 100 women with genuine stress incontinence were
                                                                              produced statistically significant improvements in all micturition
examined preoperatively, how their involuntary loss of urine can affect       variables when compared to placebo. Results were comparable between
their quality of life, using Donald L. Patrick QoL questionnaire. Burch
                                                                              male and female patients. For tolterodine ER 4 mg OD, micturitions
colposuspension was performed in all these cases. During the follow-up        were decreased by 17%, incontinence episodes were decreased by 53%
6 months after the surgery, the same QoL questionnaire they were given
                                                                              and volume voided was increased by 24%. For tolterodine IR 2 mg BID,
again.                                                                        micturitions were decreased by 15%, incontinence episodes were
Results: According this questionnaire, the quality of life percentage
                                                                              decreased by 46% and volume voided was increased by 21%. Overall
moved from average 41% (9 68%) preoperatively to 89% (62-100%)                tolerability was comparable, although a lower incidence and intensity of
                                                                              dry mouth was noted for the ER formulation. The percent of subjects
Conclusions: A comparison between preoperatively and postoperatively          that withdrew secondary to adverse events in the ER 4 mg OD group
QoL level indices, how deeply can successful anti-incontinence
                                                                              was 5.4%, in the IR 2 mg BID group was 5.5% and in the placebo group
operation change the well-being of former incontinent patients.               was 6.5%.
                                                                              Conclusions: The ER 4 mg OD formulation of tolterodine was found to
                                                                              be effective, safe and well-tolerated in the treatment of overactive
G.Digesu, V.Khullar and L.Cardozo
Department of Urogynaecology, King’s College Hospital, London, UK             FC1.14.07
                                                                              TOLTERODINE IS RAPIDLY EFFECTIVE IN WOMEN WITH
Objectives: The significance of the open bladder neck is uncertain.           MIXED INCOTINENCE
There are many theories about the importance of this finding but no
                                                                              J. M. Rabin, Dept. OB/GYN, Long Island Jewish Center, New York,
large studies. It has been suggested that an open bladder neck is             USA
associated with genuine stress incontinence (GSI) or that it may cause
the symptom of urgency or even detrusor instability due to urine              Objectives: Tolterodine is affective in the treatment of overactive
entering the proximal urethra. This study attempts to determine the
                                                                              bladder characterized by urge syptomatology. This prospective, open-
prevalence and significance of an open bladder neck, in an unselected         label study investigated the efficacy and safety of tolterodine in women
group of women attending a urogynaecology clinic, for the assessment
                                                                              with urogenital atrophy and mixed incontinence (with urge
of lower urinary tract symptoms.                                              predominating).
Study Methods: All women, were investigated using
                                                                              Study Methods: 135 women with a mean age of 66 (range 50-92) years
videocystourethrography (VCU). After uroflowmetry, the urinary                were treated with tolterodine 2 mg twice daily (BID) for 16 weeks.
residual was measured and the bladder filled with x-ray contrast medium
                                                                              Efficacy was assessed from patient micturition diaries and quality-of-life
at 100 ml/min. The bladder was radiologically imaged at maximum               questionnaires. Safety was determined through adverse event reports.
bladder capacity and provocative manoeuvres were undertaken. Finally a
                                                                              Results: Differences in endpoint medians between weeks 1, 16 and
pressure-flow study was performed and the urinary residual measured.          baseline, for patients who completed the study, are shown below.
Results: 4500 consecutive women, average age 55.4 years (range 27 to
                                                                                              Micuritions/       Incontinence        Vol. Voided         Pads/24h
73), were studied. 2593 of them had a single urodynamic diagnosis. 776
                                                                                              24h                24h                 (ml)
(29.9%) of these women had an open bladder neck and 1817 (70.1%)
                                                                                N             97                 98                  96                  65
had a closed bladder neck at rest. The urodynamic diagnoses are shown
                                                                                Baseline      10.3               2.7                 168                 2
in table 1.
                                                                                Week 1        -1.3(-13%)*        -1.3(-48%)*         +17(+10%)*          -0.7(-35%)*
                                                                                Week 16       -2.0(-19%*         -2.0(-74%)*         +38(+23%)*          -1.0(-50%)*
                                                                              *p<0.001 vs baseline
MONDAY, SEPTEMBER 4                                                                                                                                41

After 16 weeks of treatment, significant improvements(p<0.0001) for         correlated with the ICS measurements and those made in the upright
the Incontinence Impact Questionnaire and Urogenital Distress               position (P<0.05). There was no correlation between the PQOL scores
Inventory were also apparent (+40% and +44%, respectively).                 and examination findings in the supine and Sims’ position.
Tolterodine was well tolerated. The most frequent adverse events were       Conclusion: Examination of vaginal prolapse is unreliable if the woman
dry mouth (33%), headache (9%) and constipation (7%).                       is supine or in the Sims’ position but is reliable and correlates with
Conclusions: These findings indicate that treatment with tolterodine 2mg    symptoms and QOL impairment when the examination is performed
BID is well tolerated and leads to a rapid, sustained improvement in the    standing or using the ICS prolapse score.
debilitating urinary symptoms of mixed incontinence.

                                                                            FC1.15 VIRAL INFECTIONS IN PREGNANCY
TOLTERODINE: SELECTIVITY FOR THE BLADDER OVER                               FC1.15.01
M.B. Chancellor, Dept. of Urology, University of Pittsburgh Medical         ASPECTS OF THE INTRAUTERINE INFLUENZAL INFECTION
Center, Pittsburgh, Pennsylvania, USA.                                      D. Sigua, M. Devdariani, B. Korsantia, M. Kokhia, Scientific Research
                                                                            Institute of Perinatal Medicine Obstetrics and Gynecology, M.Costava
Objectives: The selectivity of tolterodine for the bladder compared with    38, Tbilisi, Georgia, 380009.
the salivary gland has been shown both in vitro and in vivo. This finding
has been repeated in humans, where tolterodine (2 mg, twice daily           The Influence of the influenza infection during pregnancy on the state of
[BID]), causes significantly less dry mouth (frequency and severity) vs.    the newborn has been studied. The indices of the immune system in the
oxybutynin at equivalent dosages (5 mg three times daily [TID]). The        maternal and umbilical blood have been studied. The value of the
objective of this study was to evaluate the tissue selectivity profile of   clinical and neurological conditions of the neonates and their electrical
these antimuscarinic agents by comparing dose-response effects in the       and encephalographic characteristics has been carried out. In the main
bladder vs. effects on visual accommodation.                                group (150 patients) preterm labor were in 15,5%. The hypoxic damage
Study Methods: In a double-blind, randomized, 4-way cross-over study,       of CNS (central nervous system) was in 9,4%. EEG
16 healthy volunteers (mean age 31 years) received single oral doses of     (electroencephalograph) in 68,2% of newborns were normal, and in
tolterodine 5 mg and oxybutynin 2.5, 5 and 7.5 mg. Each study period        31,8% we registered pathology of the diffusive type which manifested as
was 2 days in duration. On Day 1(baseline), subjects drank fluid hourly     a high amplitude slow activity, separate sharp waves occurred in the
for 12 hours. On Day 2, patients drank fluid hourly for 2 hours and were    different regions of the brain and spike-waved complexes and only in
then dosed. Hourly fluid consumption continued after dosing. Voiding        some cases as a flat curve during non-deep sleep. Clinical and
parameters were assessed for 12 hours post-dose, along with visual          neurological study proves the pathologic state of the CNS. In 17,4% of
accommodation (near point of vision; convergence meter) at regular          cases pathological alterations on EEG were revealed in clinically healthy
intervals.                                                                  neonates. The immune homeostasis in all neonates was characterized by
Results: A linear response in bladder effect (maximum bladder capacity)     the disbalance typical for the depression: the suppression of
was noted for the 3 doses of oxybutynin compared with baseline (2.5 mg      phagocytosis and endogenous interferon activity, reduction of T-cell
+35%; 5 mg, +45%; 7.5 mg, +57%). The bladder effect of tolterodine          percentage and also the appearance of Ig A and Ig M in the umbilical
(+93%) was approximately double that of oxybutynin (maximum                 blood. Severe immunodepression is revealed in mothers too.
changes in near point of vision of 13%, 20% and 29%) while maximum          We concluded necessity of the inclusion in high-risk group of both
change for tolterodine 5 mg was the same as for oxybutynin 5 mg (i.e.       newborns with hypoxic brain damage of the CNS and healthy ones
20%).                                                                       whose mother suffered from the flu during pregnancy .
Conclusions: The bladder selectivity of tolterodine extends beyond the
salivary gland, as effects on the bladder occur to a greater extent than
effects on visual accommodation. On the basis of these findings, it can     FC1.15.02
be expected that the normal dosage of tolterodine (2 mg BID) will have      PRENATAL DIAGNOSIS OF CYTOMEGALOVIRAL INFECTION
less clinically relevant effects on visual accommodation than the           H.N.Kirubamani, Government RSRM Hospital, Cemetry Road,
equivalent dosage of oxybutynin (5 mg TID).                                 Chennai, Tamil Nadu, India, 600 013.

                                                                            Objectives : The aim of the study is to diagnose Prenatal
FC1.14.09                                                                   Cytomegaloviral Infection among pregnant women with primary
VAGINAL PROLAPSE: DO SYMPTOMS CORRELATE WITH                                Cytomegaloviral Infection.
EXAMINATION FINDINGS?                                                       Study Methods: Prosepective study was conducted at RSRM hospital in
V.Khullar, G.A.Digesu, L.Cardozo, S.Athanasiou                              50 sero positive women for CMV infection
Department of Urogynaecology, King’s College Hospital, London, UK           Results : These cases were evaluvated from 10-26 wks ,USG,
                                                                            cordocentesis,and post natally placental and skin biopsy were carried
Objectives: Vaginal prolapse is a common problem affecting up to 30%        out.Fetal blood was analysed for specific IgM, Hb%,Platelet count,LFT
of women attending gynaecology outpatients. The aim of this study was       & Karyotyping.USG demonstrated Microcephaly 16%, Hydrops
to correlate the severity of prolapse with its effects on quality of life   24%,Hydrocephalous 12%,Hydranencephalous 8%,Anencephalous 2%,
(QOL).                                                                      Limb deformity 4%,IUGR with oligohydramnios 12%, Normal
Study Methods: Two experienced clinicians digitally examined women          12%.Seventy Eight percent of the pregnant women were asymptomatic
with vaginal prolapse in the conventional manner in Sims’ position and      and screened in view of bad obstetric history and 22% had
using the ICS prolapse score (POP-Q). A second group of women were          symptoms.Cordocentesis showed IgM positive in76%, it is because fetal
examined in the same manner in the supine and standing positions. A         response to infection is less below 20 wks of gestation.Placental and
quality of life questionnaire (PQOL) was developed to assess symptoms       Skin Biopsy showed inclusion bodies on histologic sections.Newborn
of prolapse and quantify their severity.                                    were normal both clinically & immunologically when USG was normal.
Results: 43 women were examined in the Sims’ position digitally and         Conclusion : Though USG Observation were conclusive, skin and
using the POP-Q. Digital examination only showed poor inter-observer        placental biopsy provides additional information in sero positive and
reliability with a Kappa value of 0.54. The POP-Q showed a high degree      conclusive in sero negative cases
of reliability with the 95% confidence interval for the difference
between examiners being 0.9 cm at most. 183 women were examined
lying supine and standing. The inter-observer reliability of the supine     FC1.15.03
examinations was poor with a Kappa value between 0.29 - 0.52.               CONGENITAL CYTOMEGALOVIRUS INFECTION IN JAPAN
However when the women were examined standing the Kappa value               T. Hoshiba, Y. Yabuki, Dept. OB/GYN, Ishikawa Prefectural Central
was 0.76 to 0.91 showing that this method was reliable.                     Hospital, Kanazawa, Ishikawa, Japan.
The PQOL form was validated in 125 women who completed the form
twice one week apart. The questions had a good inter-rater reliability      Objectives: The aim of this study was to investigate intrauterine
with a Cronbach alpha of (0.80-0.96). The severity of PQOL scores           transmission of cytomegalovirus (CMV) in Japan using cord blood.
42                                                                                                                       MONDAY, SEPTEMBER 4

Study Methods: CMV IgM antibody in cord serum was measured with              There was a trend of increasing seropositivity with age in all three
IgM antibody capture ELISA. The sera were collected from 3314 infants        groups, however only Parvovirus B19 reached statistical significance.
born in our hospital from 1994 to 1998.                                      The incidence of all the three infections were higher among the Malays,
Results: 8 of 3314 infants had CMV IgM antibody or intrauterine              Indians and other races compared to the Chinese.
transmission of CMV. The total IgM antibody was more than 20 mg/dl           Conclusion: CMV is the commonest congenital infection in pregnancy,
in five sera. 6 of 8 mothers were multipara and 3 had seroconversion. 3      and it is endemic in Singapore. Seropositivity does not protect against
pregnancies resulted in premature birth; 2 were due to PROM and the          re-infection or fetal infection. Toxoplasmosis seropositivity is low in our
other hydrops fetalis with atresia ani and hypoplastic left ventricle. The   population compared to neighbouring Asian countries. Screening for
case with hydrops died one day after delivery. 1 of the premature infants    Parvovirus may be important in cases of non-immune hydrops, as it is
developed spastic quadriplegia.                                              not uncommon.
Conclusions: In Japan 0.24% of infants were found congenitally infected      Prevention of congenital CMV, Toxoplasmosis and Parvovirus infection
with CMV and some of them developed handicaps. Multiparity and               is mainly by educating the antenatal population.
seroconversion were the risk factors. Although rare, CMV infection
must be carefully examined during pregnancy and after birth.
                                                                             CYTOMEGALOVIRUS INFECTION AND PREGNANCY
FC1.15.04                                                                    N. Merabishvili (1), T. Tsertsvadze (2),(1) Faculty of OB/GYN, Tbilisi
VERTICAL TRANSMISSION OF HUMAN PAPILLOMAVIRUS;                               State Medical University, Georgia, Russia, (2) Tbilisi Center of AIDS
PRELIMINARY RESULTS OF TURKU-RESEARCH                                        and Clinical Immunology, Georgia, Russia
M. Rintala 1), S. Grenman1), U. Ekblad1), E. Isolauri2), P. Kero2), M.
Puranen4), P. Pöllänen1) 3) and S. Syrjänen4)                                Objectives: The aim of this study was to investigate the incidence of
1) Dept. OB/GYN and 2) Dept. of Pediatrics, Turku University Central         cytomegalovirus (CMV) infection in pregnant women and the outcome
Hospital, 3) Inst. of Biomedicine and 4) Inst. of Dentistry and MediCity     of pregnancy in cases of the above infection.
Research Laboratory, Faculty of Medicine, University of Turku, Turku,        Materials and Methods: The cohort under study was divided into 2
Finland                                                                      groups: the first group consisted of 45 women with physiological
                                                                             anamnesis, the second group consisted of women with aggravated
Objectives: The purpose of the 3-year long follow-up study is to             obstetrical anamnesis (spontaneous abortion, premature labor, stillbirth).
evaluate transmission of human papillomavirus (HPV) infection from           The blood serum, anti-CMV IgM, IgG class and IgG avide antibodies
parents to neonates.                                                         were detected using the method of immonoenzime analysis.
Study methods: At the moment the study population consists of 150            Results: In the first group, the IgG antibodies were detected in 26
families; 18-27 year old mothers, fathers (42%) and neonates delivered       pregnant women (57.7%), 6 women had IgM antibodies. Among those
at Turku University Central Hospital. HPV DNA was studied by cervical        latter 3 were detected low-avide IgG antibodies (primary active
and oral swab samples from pregnant woman and by oral swab and               infection), 3 had high-avide IgG antibodies (the reactivation of the latent
semen samples from father. HPV DNA of neonate was tested by oral             infection). The premature labor was observed in 8 cases, of those 4 had
and genital swab samples immediately and three days after the birth.         IgM antibodies. The percent of premature labor in cases of active
Follow-up is at 1, 2, 6, 12, 24 and 36 months after the birth.               infection was rather high (66.7%) compared to the pregnant women who
HPV DNA is detected by nested PCR (MY09/11 and GP05+/GP06+)                  did not have IgM antibodies (10.3%).
targeting the L1 region of the HPV genome. The specifity of PCR was          In the second group, the IgG antibodies were found in 34 women
confirmed by nonradioactive Southern blot hybridizations.                    (65.4%), 8 had IfM antibodies (15.4%), of those 3 had the primary
Results: Of the mothers 20.3% (16/79) of cervical and 15.4% (16/104)         active infection while 5 had reactivation of the latent infection.
of oral samples were HPV DNA positive, of which high risk HPV types          Premature labor was observed in 12 cases. Of those, in 4 cases was
were identified in 15.2% (12/79) and 12.7% (7/55), respectively. Two         detected IgM antibodies. In 1 of the latter 4 cases, the patient had a
months after the delivery 19.3% (11/57) of cervical samples were still       primary active infection, 3 – reactivation of the latent infection. In cases
HPV DNA positive. In neonates just after delivery 17.2% (11/64) of           of active infection, the percent of premature labor was rather high – 50%
genital and 34.9% (22/63) of oral samples were HPV DNA positive;             - compared to the IgM seronegative pregnant women.
high risk types were 14.1% and 28.6%, respectively. One month after          Conclusion: The prevalence of the CMV was rather high in both groups
the delivery still 9.5% (8/84) of genital and 12.0% (9/75) of oral samples   of the pregnant women under study being somewhat higher in women
were HPV DNA positive. Two out of 12 (16.7%) fathers had an HPV              with aggravated obstetrical anamnesis: 57.7% and 65.4% respectively.
DNA positive semen sample by PCR.                                            The analysis of the results demonstrated that in cases of active infection
Conclusions: The detection rate of HPV DNA in pregnant woman was             (both primary active infection and reactivation of latent infection) the
similar to that repated earlier (20%). Newborns of these mothers had         percent of premature labor was higher compared to the sero-negative
high detection rate of HPV DNA both in oral and genital regions. HPV         pregnant women.
was not only a transient passager, but causes a true infection, while 12%
of the children at the age of one month still have HPV DNA.
                                                                             MORPHOLOGICAL ASPECTS IN CLINICAL DIAGNOSTIC OF
FC1.15.05                                                                    PLACENTAL INSUFFICIENCY IN PREGNANT WITH HERPES
SINGAPOREAN PREGNANT WOMEN                                                   Tioutiounnick V.L. Research Centre of Obstetrics, Gynecology &
A Wong, KH Tan, CS Tee, GSH Yeo                                              Perinatology, Moscow, Russia
Department of Maternal Fetal Medicine, KK Women’s and Children’s
Hospital, 100 Bukit Timah Road, Singapore 229899                             Objectives: The necessity to study herpes virus infection (HSV, CMV) is
                                                                             mandated by a countinuing increase of the number of patients affected
Objectives: The aim of our study was to determine the seroprevalence of      by that disorder, high rate of perinatal losses and by birth of babies with
Cytomegalovirus (CMV), Toxoplasma and Parvovirus in our local                severe brain damage.
antenatal population.                                                        Methods: The analysis of the pathomorphological researches of the 177
Study methods: 120 consecutive antenatal women seen in a private             samples of women with herpes virus infection in comparison with the
clinic in KK Women’s and Children’s Hospital between the period of           peculiarities of pregnancy, functional status of fetal placental complex
October 1997 and March 1998 were included. Blood was taken for               and the condition of newborns and neonates was performed.
CMV IgG, Toxoplasma IgG and Parvovirus B19 IgG and IgM.                      Results: We obtained following results: the herpes virus infection leads
Results: The mean age was 29.2 years, the mean gestation was 19.0            to decrease of fetal and maternal blood flow in 17.6%, intrauterine
weeks and the mean parity was 1.0. 81.7% of the patients were Chinese,       growth retardation in 21.7%, intrauterine hypoxia in 29.6%. It was found
1.7% were Indians, 3.3% were Malay and 3.3% comprised other races.           out, that this infection leads to significant changes in afterbirth, such as
A total of 87% of the patients were seropositive for CMV IgG, 17.2%          lymphoplasmacytic infiltration, vascular damage and sclerosis. The
were positive for Toxoplasma IgG and 30% were seropositive for               character of changes directly depends on frequency, duratation and
Parvovirus IgG.                                                              periods of the disease relapses.
MONDAY, SEPTEMBER 4                                                                                                                                    43

Conclusions: Women with herpes simplex virus and cytomegalovirus               behavior with highest (but not significantly) levels in pregnancy then six
must be included in a high risk group, due to the possibility of fasiliating   months after delivery.
placental insufficiency.                                                       The vertical/perinatal transmission was verified in two cases (4.8%) at
                                                                               3rd month of life. Both mothers were not HIV coinfected.
                                                                               Conclusions: HCV infection does not increase the risk of obstetrics
FC1.15.08                                                                      complications and there is no risk to pregnancy outcome. We report a
ACCURACY OF THE SEROLOGICAL TEST ELISA COMPARED                                higher risk of maternal cholestasis: 11.8% versus 1-2% of general
TO POLYMERASE CHAIN REACTION (PCR) FOR THE                                     obstetric population. The vertical/perinatal transmission of HCV
DIAGNOSIS OF CYTOMEGALOVIRUS (CMV) INFECTION IN                                infection is low (4.8%).
S.V.Parmigiani, R. Barini, S.C.B.Costa, R.Zaccaria, Dept.
OB/GYN,University State of Campinas, Campinas, São Paulo, Brasil.              FC1.16 ABORTION 2

Objectives: The objective of this study was to evaluate the accuracy of        FC1.16.01
the serological test ELISA (Enzyme Linked Immunosorbent Assay) for             TERMINATION OF PREGNANCY WITH VAGINALLY
the diagnosis of cytomegalovirus (CMV) infection, compared to                  ADMINISTERED MISOPROSTOL
polymerase chain reaction (PCR).                                               S. Ahsan, A, Ahsan, S. Naeem, F. Qayyum, Liaquat National Hospital,
Study Methods: A descriptive study was performed selecting 243                 Stadium Road, Karachi, Sindh, Pakistan, 74800.
pregnant women at PNE/CAISM/UNICAMP. All had indication for
fetal blood sampling for reasons other than suspicion for CMV infection        Objectives: To investigate the efficacy of vaginally administerd
and also for suspcion of CMV infection. This group of women were               Misoprostol, for therapeutic termination of pregnancy.
studied through venous blood samples tested for CMV. Serological tests         Study Methods: This is an ongoing observational study of 35 patients so
were run and compared to PCR, used as gold standard.                           far, who required therapeutic termination of pregnancy regardless of
Results: The rate of CMV infection determined through IgG was 94,6%.           trimester, at Liaquat National Hospital, a tertiary care medical facility.
The main reasons for study inclusion were fetal SNC malformation               Misoprostol in doses varying from 100 to 400 mg (depending on parity
(25,5%), maternal toxoplasmosis (25,5%) and Rh incompatibility                 and previous LSCS) in initial doses was administered vaginally, and the
(14,8%). Only two women were included because of suspected of CMV.             outcome recorded regarding complete/incomplete abortion and the time
The sensitivity and specificity of serological tests were 94% and 6% for       interval from induction to complete abortion. The complications were
IgG; and 4,0% and 100% for IgM.                                                also noted.
Conclusions: We concluded that the serological tests had lower                 Results: 17 out of 35 cases resulted in complete abortion. 18 cases
sensitivity compared to PCR test in the diagnosis of infection of CMV.         needed evacuation of uterus following incomplete abortions. The time
Future consequences of positive PCR and negative IgM women is                  interval ranged from 6 to 36 hours. There were no complications.
unknown.                                                                       Conclusions: Misoprostal administered vaginally for termination of
                                                                               pregnancy appears to be safe and effective in initiating the process, and
                                                                               in this preliminary analysis appears to result in complete abortion in
FC1.15.09                                                                      approximately 50% of cases. More cases need to be evaluated.
D. M. Paternoster (1), C. Santarossa (1), A. Parise (1), G. Palu (2),
C. Mengoli (2)                                                                 FC1.16.02
(1) Obstetric and Gynecological Department, University of Padova, Italy        THE USE OF PROSTAGLANDIN E1 IN MISCARRIAGE AND
(2) Virology Department, University of Padova, Italy                           TERMINATION OF PREGNANCY DURING THE FIRST
Objectives: The aim of this study is to investigate the clinical and           E.Kolibianakis, E.Vardaki, S.Sifakis, E.Angelakis, G.Mikelakis,
biochemical aspects of hepatitis C virus (HCV) infection during                N.Martavatzis, E.Koumantakis. Dept.of Obstetrics-Gynecology,
pregnancy and after delivery and to evaluate the percentage of                 University Hospital of Heraklion, Crete, Greece
vertical/perinatal transmission of HCV.
Study Methods: The study concerned 11 681 consecutive pregnant                 Objectives: The use of prostaglandin E1 (misoprostol) in miscarriage
women screened in the Obstetric Department for High Risk Pregnancy             and termination of pregnancy during the first trimester, is a promising
at the University of Padova, Italy, between 1992-1999. Each woman              alternative method to dilatation and curettage (D+C), combining a low
underwent the following: serological screening for hepatitis B surface         cost of treatment without the need of general anesthesia.
antigen (HbsAg), HCV serum markers (anti-HCV, GCV-RNA, viral                   Study Methods
load), antibodies to human immunodeficiency virus (HIV), AST and               33 women (11 primigravidae and 22 multips) with mean age 30.1 years
ALT levels. HCV-RNA was searched in neonatal blood at birth and then           were studied. The mean gestational age was 8w5d by LMP and 7w2d by
at 3rd, 6th and 12th month of life.                                            USS. 27 women were diagnosed as missed abortion, 3 women as failed
Results: Of the 11 681 pregnant women 135 (1.15% tested were positive          termination while 5 women requested termination of pregnancy.
for the presence of anti-HCV antibodies. Of the135 anti-HCV positive           Misoprostol treatment was given as 400 _g 4hourly intravaginally until
mothers observed at initial screening 80 (59.2%) were found positive for       an empty uterus was confirmed by USS (max daily dosage1600 _g, for a
HCV-RNA, 31 (22.9%) were HCV-RNA negative and 24 (17.8%) were                  maximum 3 days). Treatment failure occurred when there were still
not tested for HCV-RNA. Of the 80 HCV-RNA positive mothers 12                  products of conception in the uterus following three days of misoprostol
(15%) were also HIV coinfected and 3 (3.7%) HBV coinfected. Four               treatment, when life threatening bleeding complicated treatment or when
(5%) of the 80 HCV-RNA positive women incurred in stillbirth, one              the patient could not accept the continuation of treatment due to personal
(1.25%) in fetal death, one (1.25%) in neonatal death (at 27th g.w. for a      reasons (pain, anxiety). During treatment and for the time period vaginal
placental detachment). The remaining 74 HCV-RNA positive mothers               bleeding continued (mean 6.5 days), the patient was given doxycycline
gave birth to 78 babies, including four sets of twins: 56 (70% delivered       (100mg BD). A TV USS was performed following cessation of vaginal
at term and 18 (22.5%) preterm. The reason of preterm deliveries were          bleeding, while a hydroultrasonogram was performed one month
strictly obstetrics.                                                           following treatment success in all women.
Nine (11.8%) pregnant women developed a cholestasis at 2nd or 3rd              Results: The mean dosage of cytotec given was 1200 _g, while the mean
trimester. AST levels were significantly reduced from the 1st to the 2nd       time required for treatment success was 22 hours. Mean bHCG at
trimester (37.2±24.4 versus 29.3±15.6 U/L, p=0.05) and significantly           initiation of treatment was 22337 IU and declined to non-pregnant levels
increased from the 2nd trimester to six months after delivery (29.3±15.7       after 2.5 weeks. Mean hemoglobin declined from 11.8 to 11.6 g/dl
versus 43.2±28.2 U/L, p=0.02). ALT levels resulted significantly               (p=0.02) following treatment. Dilatation and curettage was performed in
reduced from the 1st to the 2nd trimester (49.6±31.5 versus 32.4±20.8          three women for anxiety and absence of a uterine response resulting in a
U/L, p=0.03) and significantly increased six months after deliver in           treatment success rate 91%. All patients in whom treatment with
confront of the 2nd and 3rd trimester (65.3±53.4 versus 32.4±20.8,             misoprostol succeeded were satisfied and did not complain for
p=0.003 and 38.5±43.4 U/L, p=0.03). The viral load showed a variable           symptoms more than those present typically during menstruation, with
                                                                               the exception of one patient who was admitted in the hospital as
44                                                                                                                    MONDAY, SEPTEMBER 4

products of conception were present at the cervix causing excessive          FC1.16.05
pain. Hydroultrasonography showed a normal uterine cavity and                SELF-REPORTS OF INDUCED ABORTION: AN EMPATHETIC
endometrium in all women.                                                    SETTING CAN IMPROVE QUALITY OF DATA
Conclusion: Misoprostol treatment in cases of first trimester miscarriage    V Rasch, Department of Obstetrics and Gynecology, Odense University
as well as for medical termination of pregnancy is an efficient method,      Hospital, Odense, Denmark. Ernest Urassa, Department of Obstetrics
more advantageous than D+C, as it combines low cost, it can be               and Gynaecology, MMC, Dar es Salaam, Tanzania. S Bergstrom,
performed in an outpatient service, avoids trauma to the uterus and the      Division of International Health Care Research (IHCAR), Karolinska
cervix and does not require general anesthesia                               Institutet, Stockholm, Sweden.

                                                                             Objectives: To estimate the magnitude of induced abortion in hospital-
FC1.16.03                                                                    based settings in Tanzania.
EVALUATION OF MANUAL VACUUM ASPIRATION (MVA) FOR                             Study Methods: Cross-sectional questionnaire study. The study was
TREATMENT OF INCOMPLETE ABORTION                                             carried out in two phases. The first one at Temeke District Hospital
A.A. Youssef, S.A. Abdulla, A.M. Sabra, A.M. Ismail, Dept. OB/GYN,           (TDH) and Muhimbili Medical Centre (MMC), Dar-es-Salaam,
Assiut Medical College, Assiut, Egypt.                                       Tanzania and Dodoma Regional Hospital (DRH), Dodoma Region,
                                                                             Tanzania. The second at TDH and MMC. Phase one included 302
Objectives: Comparison between Manual Vacuum Aspiration (MVA)                patients and phase two 832 patients with the diagnosis incomplete
and the traditional method of dilation and curettage (D & C) in              abortion.
management of incomplete abortion as regard to the efficiency, time          Results: In phase one cases were classified using a set of standard
factor, pain control, method, complications and duration of hospital stay.   clinical criteria and information provided from the patient. The
Study Methods: The study included 160 patients with first trimester          proportion of patients identified as “certainly induced” abortion ranged
incomplete abortion. 80 patients were manages by MVA and 80 patients         from 3.9% at DRH to 16.1% at MMC. In phase two the structured
were managed by traditional dilation and curettage under general             interview method was changed to an empathetic personal dialogue.
anesthesia.                                                                  Previously used clinical classification criteria were omitted. In phase
Results: The results showed that the mean volume of blood loss during        two 60.0 % were classified as “certainly induced” abortion at TDH and
MVA procedure was 32 ± 13 ml compared to 62 ± 35 ml in D & C                 30.9% at MMC.
procedure, the difference was statistically significant. The length of the   Conclusions: An empathetic dialogue improves the quality of data
procedure of MVA was 4.2 minutes compared to 9.2 minutes in D7 C.            collected among women with induced abortion. Furthermore, our results
The difference was significant. The MVA procedures didn’t require            indicate that the majority of women with alleged miscarriage in Dar-es-
general anesthesia, 5% of the patients suffered no pain and received no      Salaam may have induced abortions.
medication, 42.5% of patients suffered mild pain and received analgesia,
16.2% suffered moderate pain and only 6.2% of patients suffered severe
pain that required analgesia and anexiolytics. Regarding the                 FC1.16.06
complications, 6.5% of MVA procedures associated with excessive              EVALUATION RATE OF EFFICACY AND COMPLICATION OF
bleeding during operation compared to 22.5% with D&C (P<0.05). No            IUD TCU 380 A AMONG IUD TCU 380 A USERS IN ISFAHAN
cervical lacerations or uterine perforation or postoperative persistent      HEALTH CENTERS DURING 1996-1997
pain or foul discharge occurred with either method.                          B. Khanirabati, Dept. OB/GYN, Isfahan Medical University, Isfahan,
Conclusions: The MVA procedure for treatment of first trimester              Iran.
incomplete abortion is a safer, effective method, associated with little
blood loss, short operative time, less hospital stay with minimal pain       Objectives: Regarding the different contraceptive methods for
control medications, so this procedure could be done as an outpatient        controlling increase of the population in the world in this study was
procedure.                                                                   performed to evaluate rate of efficacy and complication of IUD TCU
                                                                             380 A among users of this IUD in Isfahan Health Centers.
                                                                             Study Methods: In this study, we inserted IUD TCU 380 A for 767
FC1.16.04                                                                    parous women who had come to Isfahan Health Centers for insertion of
ORAL MIFEPRISTONE AND VAGINAL MISOPROSTOL WITH OR                            IUD and followed them for 1 year in several visits (1 week – 1 month, 6
WITHOUT ORAL MISOPROSTOL IN EFFECTING TERMINATION                            and 12 months after insertion) during 1996-1997.
OF PREGNANCY AT GESTATIONS FROM 5 TO 23 WEEKS.                               Results: In this study, success rate was 99.3%. The most frequent
J. Ojidu, and S. Sabharwal, Dept. OB/GYN Scunthorpe General                  complication was hypermenorrhea (44.4%) and the majority of
Hospital, Scunthorpe, DN15 7BH, United Kingdom.                              complications occurred 7 to 8 months after IUD insertion and then
                                                                             reduced. Papsmear was normal in (55.3%) of women.
Objective : To assess the effectiveness and complications associated         Removal rate was 13.8% and the most frequent cause was
with the use of Mifepristone and Misoprostol as the sole method of           hypermenorrhea. Expulsion rate was 3.4% and PID was seen in 0.4% of
termination of pregnancy at all gestations from 5 to 23 weeks.               women.
Methods : Case notes review of medical termination of pregnancy              The major recommended source was health centers (76.7%) and 90% of
invoving 482 women from December 1997 to June 1999 was                       couples were satisfied with this method.
undertaken. The women received 200mg Mifepristone orally, followed           Conclusion: IUD TCU 380 A is safe and effective and represents a
36-48 hours later by 800micrograms of misoprostol vaginally for              suitable contraceptive alternative for the appropriate patient.
gestations up to 9 weeks and 400micograms of Misoprostol orally at 3
hourly intervals for up to 3 doses for gestations over 9 weeks. The
gestations range from 5 to 23 weeks.                                         FC1.16.07
Results : Complete abortion was achieved in 403(84%)women. Surgical          COMPARSION OF EFFECTIVENESS BETWEEN NON-INVASIVE
intervention was required in 79(16%) women to complete the abortion.         MISOPROSTOL AND INVASIVE DINOPROST FOR SECOND-
The complete abortion rate was similar across the spectrum i.e. 87% in       TRIMESTER PREGNANCY TERMINATION
the 5-8 weeks group; 79% in the 09-13 weeks group; and 88% in those          M. Kuritka, Z. Maly, Dept. OB/GYN, University Hospital, Jihlavska 20,
of 14 weeks and above. Two failures altogether, one of them proceeded        639 00 Brno, Czech Republic
to surgical termination after 2 courses and the other continued with her
pregnancy after one course. Three other women required 2 courses of          Objectives: To compare the effectiveness of misoprostol versus
Misoprostol to succeed. Complications were remarkably low. One               dinoprost for termination of second-trimester pregnancies.
woman required 2 units of blood transfusion for haemorrhage while 2          Study methods: Our study population consisted of eighty-four women
others were treated for infection.                                           who requested termination of pregnancy between 13th and 28th week.
Conclusion : Oral Mifepristone followed by vaginal Misoprostol with or       Thirty-one women were treated by dinoprost intraamnially from January
without oral Misoprostol is an effective and safe regimen for termination    1998 to June 1998. Fifty-three women were treated from July 1998 to
of pregnancy for gestations from 5 to 23 weeks                               January 2000 by misoprostol vaginally and if necessary also orally. We
                                                                             maintained the duration of abortions, the use of prostaglandins and
MONDAY, SEPTEMBER 4                                                                                                                                   45

Results: The patients in the misoprostol group aborted within a               90.19%. The knowledge about physiology of reproduction before course
significantly shorter time (mean 13 hours and 10 minutes) than those in       was 17.64%, after course, 88,24%. The knowledge about pathology of
the dinoprost group (18 hours and 50 minutes, P<0.01). The mean               gynecology before course was 13.73% and after course, 78.43%.
abortion expense in the misoprostol group was 3.43 $, the mean abortion       Conclusions: There was a significant increase in the participants’
expense in the dinoprost group was 78.98 $ (P<0.01). There was no             knowledge about reproductive health.
failure of any method and no significant difference between
complications within these two groups.
Conclusions: Misoprostol is a safe agent for second-trimester pregnancy       FC1.17.03
termination. The administration is not invasive which causes less pain to     EXPERIENCE OF THE FIRST PELVIC EXAMINATION
the patient and reduces the risk of intraamnial infection. The duration of    S. Gupta (1), R. Hogan (2), R. Kirkman (3)
abortion is shorter and it is less expensive than dinoprost.                  (1) Women’s Services, Forest Healthcare Trust, London, UK.
                                                                              (2) Dept. of Family Planning, Mancunian Trust, Manchester, UK.
                                                                              (3) Dept. of Family Planning, University of Manchester, Manchester,
FC1.17 ADOLESCENT GYNECOLOGY 2                                                UK.

FC1.17.01                                                                     Objectives: To identify positive and negative components of the first
ADOLESCENT GYNAECOLOGICAL PROBLEMS IN TRIBAL                                  pelvic examination and incorporate positive components in a model of
POPULATION OF BIHAR (INDIA)                                                   good study clinical practice.
S. Chakraborty, Dept. OB/GYN, Rajendra Medical College Hospital,              Methods: 167 women under 25 years of age filled out an open cross-
Bihar, India.                                                                 sectional questionnaire within clinics in the Mancunian Community
                                                                              Trust, Manchester. 163 responses were analyzed with Mann Whitney
Objectives: The study aimed to investigate into the problems of local         and Chi Square tests. 2% of the questionnaires were incomplete and not
adolescent tribal population. Important gynecological problems were           included in the analysis.
documented. Study was targeted towards working out the modes of               Results: There was a significant trend of positive experience compared
awareness creation, prevention & treatment of the maladies.                   to expectations if the examination was conducted by a female doctor
Study Methods: 100 gynecological cases were studied, during the period        (P=0.02), if the doctor asked permission (P=0.001) and if the
January 1999-December 1999. History, followed by clinical exam was            examination was in a Family Planning Clinic compared to a GP surgery
carried out. Lab investigations were done. Protocol was designed for          (P=0.4) and if the average age of the girl being examined was 18 as
every case group regarding its management. The findings were analyzed         opposed to 16 (P=0.004). A large proportion of doctors did not seek
to formulate the treatment protocol and to go into the depths of it’s         permission before examination. There were no significant differences in
overall medical and social implications                                       experience and expectations with offer of a chaperone. The women
Results: Menstrual problem (40 cases) 16 pubertal menorrhagia.                considered a female doctor, a friendly doctor, ability to ask questions
Oligomenorrhoea (10 cases), 14 cases of amernorrhoea (10 were                 and an uninterrupted examination as important aspects of an internal
primary & 4 secondary). Dysmenorrhoea – 20 (Spasmodic                         examination.
dysmenorrhoea, endometriosis & pelvic inflammation). Ulterine                 Conclusion: A friendly female doctor seeking permission before the
anomalies –10 (including mullarian agenesis as well as dysgenesis).           examination which should be uninterrupted, were considered important
Polycystic ovaries (16 cases). Tumors and Ulcers – 10( dysgerminonia          aspects of an internal examination and should be incorporated as a
(3), Epithelial tumor (1), Dermoid (3), Vulvar Ulcer (1), Uterine             model of good clinical practice.
Sarcoma (1) & Sercoma Cx. (1)). Reproductive tract infections (4 cases).
Conclusions: The findings stressed the need of developing an adolescent
care sub-specialty. Lack of awareness and social motivation was a prime       FC1.17.04
cause for late presentation in most of the cases. This further stresses the   PROBLEMS OF ADOLESCENT GIRLS – A POPULATION-BASED
need of a core group approach to the problem, with gynecologist,              STUDY
medical social workers and various govt. & non-govt., bodies joining          R.K. Sarin (1), S. Goel (2), A.R. Sarin (1)
hands to work for this special age group.                                     (1) Dept. OB/GYN, Aastha Medical Center, Patiala, Punjab, India.
                                                                              (2) Dept. OB/GYN, Medical College Hospital, Patiala, Punjab, India.

FC1.17.02                                                                     Objectives: The aim of this study was to investigate the medical and
ADOLESCENT REPRODUCTIVE HEALTH COURSE IN                                      social problems among adolescent girls.
INDONESIA                                                                     Study Methods: Two thousand adolescent girls belonging to rural and
S. Adije, Dept. OB/GYN, Cipto Mangunkusumo General Hospital,                  urban areas and slums of Patiala district were studied in this population-
Jakarta, Indonesia.                                                           based face-to-face survey using a specially designed questionnaire. The
                                                                              interviews were conducted in schools or in the homes if they were not
Objective: To increase knowledge among adolescents about                      going to school. Besides interviews, a physical examination and Hb
reproductive health.                                                          estimation were done.
Design/Identification: Course and questionnaire, Descriptive study            Results: 17.2% of these girls were already married. The average age of
Setting: Dept. OB.GYN, Faculty of Medicine, University of Indonesia,          menarche was found to be 14.1 years. Most of these girls were found to
Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia                   anemic (87.3%), malnourished (59.4%) and had menstrual problems
Subject: High school students in Jakarta who participate voluntarily in       (51.4%), mainly dysmenorrhea. Sexual/physical abuse was admitted to
the course. There was a test prior to the course subjects of:                 by 2.7% of girls. Vaginal discharge was complained of in 3.2% cases. A
• The anatomy of male and female reproductions                                significant number (32.8%) had no knowledge about STD and
• The function of female’s reproduction process, from menstruation to         contraception although 47.5% of girls were aware of gender
   pregnancy and delivery.                                                    discrimination.
• The function of male’s reproduction                                         Conclusions: Rampant malnutrition, anemia, gynecologic problems and
• The cycle of healthy reproduction                                           physical/sexual abuse found in this study may have devastating effects
• The risk of underage/teenage pregnancy with all of its complications        on the future adult female, demanding serious attention of the health-
• The gynecology                                                              planners.
• The importance of reproduction’s responsibility
• After course, there was a post-test.
Intervention: Interactive course (with a pre- and post-test).
Results: From 54 participants, 37 female and 17 male, on average have
never been in a similar course before. The age of the participants ranged
from 15 to 17 years. Before the course, average points were 5.83 with
lowest point of 0 and the highest was 8. After course, average points
were 9.33 with the lowest of 7 and the highest was 10. The knowledge
of reproduction anatomy before course was 13.73%, after course,
46                                                                                                                      MONDAY, SEPTEMBER 4

FC1.17.05                                                                     Objective: To study the characteristics of breast-feeding among
INTERPERSONAL EXPERIENCES, ATTITUDES AND                                      adolescent mothers.
CONTRACEPTIVE USE AMONG HIGH-SCHOOL STUDENTS IN                               Study Methods: 200 women aged 13-22 (average 14.8) who delivered
SLOVENIA                                                                      their first child under 19 years old were interviewed. Data were collected
B.Pinter (1), M.Tomori (2), (1) University Medical Center, Slajmerjeva        by a PhD and assessed in a structured form. It was considered successful
3, Ljubljana, Slovenia, 1000, (2) University Dept. of Psychiatry,             when lasting 6 or more months (Group A) and not satisfactory less than
Ljubljana, Slovenia.                                                          5 months (Group B) – X2 test was used for statistical validation.
                                                                              Results: 58.5% of adolescent women showed successful breast-feeding.
Objectives: The aim of the research was to study interpersonal                According to age, mothers under 15 years old were unsuccessful in
experiences, attitudes and contraceptive behavior of high-school              56.4% of cases, compared to 37.9% of those older than 16 (p<0.05).
students in Slovenia.                                                         Average duration for Group A was 12 months and for Group B 3 months
Study Methods: The research was done on 4706 high-school students in          (no breast-feeding at all was excluded).
Slovenia aged 15-19 years. The data were obtained by self-administered        Mothers with lower education level showed a better performance (72.4%
questionnaire in April 1996.                                                  in Group A compared to Group B: 27.6%). Appropriate advice prior to
Results: The average age of the students was 17.2 years, the same for         delivery was the strongest associated factor for success (p<0.001).
both genders. The majority of the students have had experiences in            Family group and their own breast-feeding did not appear an important
kissing (70%), caressing (59%), and less in petting (43%). Sexual             factor in this sample. The reasons for interruption could have been
intercourse have ever had 38% of the students. By the age of 19.0 years       prevented in 76.1% of cases (reduction in milk supply, back to
58% of the girls and 50% of the boys have experienced the first sexual        school/work, nipple pain or injury). Following pregnancy: 31% of the
intercourse. The main reasons for the first sexual intercourse were love      girls of Group A became pregnant within less than 2 years after delivery
(45%), incident (22%) and curiosity (15%). Contraceptive methods              (p<0.0001). Contraception use rate was 33.6% in Group A and 45.2% in
currently used were condom (60%), pills (14%), withdrawal (4%), other         Group B. Preferred methods were OC (44.7%) and condom (30.26%).
methods (3%) and no method (19%). The most appropriate sources of             Conclusions: Very young adolescent mothers were less able to breast-
information on sexuality were friends (26%), parents (19%), different         feed their babies. Notice and preparations for breast-feeding are a very
sources (19%) and professionals (15%); less appropriate were books            important strategy for success. With appropriate counseling, 76.1% of
(9%), individual experiences (7%), school (3%) and media (2%).                mothers might have been able to continue breast-feeding. Contraception
Conclusions: By the age of 18.5 years about a half of high-school             use should be encouraged in these girls in order to promote birth-
students in Slovenia have experienced sexual intercourse. The majority        spacing.
(74%) of the students currently use effective contraception, condom
being the most popular. Peer education could be the most appropriate
form of sex education in Slovenia.                                            FC1.17.08
                                                                              EVALUATION OF THE PHYSICAL AND PSYCHOLOGICAL
                                                                              REACTIONS OF INDIAN PARENTS WITH FEMALE CHILDREN
FC1.17.06                                                                     SUFFERING FROM CANCER IN A PEDIATRIC ONCOLOGY
ADOLESCENCE                                                                   K. Gupta, N.R. Mondol, I. Basu Mallik, B. Chakraborty, Dept. Of GYN,
S. Malhotra, Department of Obstetrics & Gynaecology, Govt. Medical            Cancer Center Welfare Home & Research Institute an Child Care
College Hospital, Sector-32, Chandigarh ,India                                Center, Thakurpukur, Calcutta, India.

Objective: To review the Gynaecological problems of childhood and             Objectives: The aim is to evaluate the physical and psychological
adolescence.                                                                  reactions of 50 Indian parents with female children suffering from
Study method: One hundred and two girls (between the ages of 1-20             cancer in a pediatric oncology center.
years) attending the pediatric adolescent Gynae Clinic were reviewed for      Study Methods: Families who had a child with cancer in the age group
their problems.                                                               of 2-13 years were divided into four groups:
Results: Seventy one girls (69.6%) presented to the clinic with menstrual     Group A: Child was newly diagnosed with cancer
problems and 31 girls (30.4%) had other Gynaecological problems.              Group B: Child undergoing chemotherapy/radiotherapy and expected to
Menstrual problems ranged from amenorrohea to menorrhagia.                    live
Amenorrhea was the complaint in 18 girls, 17 girls had hypo or                Group C: Child undergoing chemotherapy/radiotherapy but not expected
oligomenorrhea, polycystic ovarian disease was significantly associated       to live
with these girls. 33 girls, presented with menorrhagia, 8 of these girls      Group D: Child had died within the last six months
necessitated blood transfusion for severe anaemia. One of these girls had     The tools employed were Taylor’s Anxiety Manifest Scale and
ITP, one had renal hypertension with renal failure and one had suspected      Hamilton’s Depression Scale. A questionnaire covering the area of age,
uterine AV malformation on Doppler. Three girls presented with severe         education, socioeconomic status, physical and psychological reactions
dysmenorrhea. Detailed etiological factors will be discussed.                 were evaluated.
Other gynaecological problems were labial fusion (4 cases)                    Results: In Group A, there were 17 children, Group B: 21, Group C: 8
vulvovaginitis in 8, ovarian cyst in 5, utero vaginal prolapse in 2. Corpus   and Group D:4. The parental anxiety scores were much higher than the
luteal rupture with massive haemoperitonium in 1, perineal injury in 2,       norm, with mothers being significantly more anxious than the fathers.
sexual assault in 8 and clitoral abscess in 1 case.                           Depression, guilt, insomnia, agitation, decreased libido and weight loss
Conclusion: Gynaecological problems of children and adolescents are           were the common manifestations in both parents
comparatively less common and at times unique to this age group.              Conclusions: In a developing country like India, having a dedicated
Parents are frequently alarmed by disease of genital/sexual organs of         pediatric oncology center has not only revolutionized the treatment of
their children which they fear may have serious repercussions in later        these innocent yet unfortunate children but has also lent tremendous
life. Separate pediatric adolescent clinics and reproductive health           support and psychological help to their parents to cope with this
education is necessary to help this group of young people.                    tremendous stress in their lives.

FC1.17.07                                                                     FC1.17.09
A. Coll (1), A. Giurgiovich (1), M. Albanese (2), A.D. Barata (1)             ABORTION
(1) Division Obstetricia – Programa de Adolscencia, Hospital de               Dr. B. Szoczei, Dr. St. Istvan Hospital, Budapest, Hungary
Clinicas, “J. de San Martin”, Buenos Aires, Argentina.
(2) Hospital “Evita Pueblo”, Berazategui, Argentina.                          In Hungary, 75 000 induced abortions are carried out annually, 11 000
                                                                              of which concern girls under 18. Though in the last 5 years the total
Breast-feeding provides important benefits to mothers and children. This      number of induced abortions decreased by 50%, the number of juvenile
is important regarding adolescent mothers, due to bio-psycho-social           operations increases every year. One can draw the conclusion:
implications of childbearing at this age.                                     youngsters do not know the methods of contraception, do not take the
MONDAY, SEPTEMBER 4                                                                                                                                 47

importance of prevention seriously, and are not aware of the dangers of     ovarian tumours( benign5% Malignant1.3%) and endometrial carcinoma
ending unwanted pregnancy.                                                  (0.2%) and the estrogen receptor status suggest that proliferation of
Since a huge percentage of families do not give enough attention to         adenomyotic foci may be the result of high estrogen concentration and
enlightening their children, only a nation-organized, organized program     impaired growth control
could make health education more effective. This subject should be
taught compulsorily at schools, where the youngsters could learn about
basic hygienic requirements, the responsibility taken in human and          FC1.18.03
sexual relationship, the prevention of venereal diseases. A well-written    MICROSATELLITE DNA INSTABILITY IN ENDOMETRIOSIS
enlightening book should become a compulsory reading and with the           REVEALS ALLELIC IMBALANCE IN P16INK4, GALT, P53 AND
help of advertisements of teenager-ambulatoriums, students could learn      APOA2 LOCI.
where to turn for advice about proper contraception.                        D.Arvanitis (1), A.Goumenou (2), E.Koumantakis (2), D.Spandidos (1),
Through the introduction of such a complex program, the number of           (1) University of Crete, Medical School, P.O. Box 1393, Heraklion,
unwanted pregnancies, venereal diseases, the frequency of infertility and   Crete, Greece, 71409, (2) University Hospital of Heraklion, Heraklion,
the rate of premature birth could decrease in a couple of years.            Crete, Greece.

                                                                            Endometriosis is a common benign gynecological condition that
FC1.18 ASPECTS OF ENDOMETRIOSIS                                             presents features of a complex trait with genetic origin. Endometriotic
                                                                            cysts seem to be monoclonal and demonstrate aggressive growth and
FC1.18.01                                                                   localized invasion of the myometrium. Moreover, malignant
ENDOMETRIOSIS: EXPERIENCE IN AN INFERTILITY UNIT IN                         transformation has been documented and it is commonly found in
LIMA, PERU                                                                  association with the endometrioid subtype of ovarian cancer. Loss of
J. Pacheco, R. Ángeles, J. Ishihara, P. Orihuela, C. Zúñiga. Human          heterozygosity (LOH) and chromosome aneuploidy have been also
Reproduction Unit, E. Rebagliati Martins National Hospital, EsSalud,        detected. Although pathogenesis of this disease remains obscure, tumor
Venecia 225, San Borja, Lima, Perú 41                                       suppressor genes and genes implicated in the metabolism of specific
                                                                            substrates have been suggested to be involved. We have used 17
Objective: The aim of the study was to review all cases of endometriosis    microsatellite markers, in one single and four tetraplex microsatellite
found during laparoscopy in women with infertility or recurrent             assays, to determine allelic imbalance in 23 cases of endometriosis. The
abortion.                                                                   markers used are located close to tumor suppressor genes, DNA repair
Study Methods: Seventy-nine women with infertility or recurrent             genes and genes, which are thought to be involved in endometriosis.
abortion subjected to laparoscopy during a six-month period were            Moreover, the markers were involved in regions frequently lost in
included in this retrospective descriptive transversal study.               ovarian cancer. Five samples (21.7%) showed allelic imbalance in at
Results: Prevalence of endometriosis was 60.7% (48 patients), more          least one locus. Loci 9p21, 1q21 and 17p13.1 exhibited imbalance (17%,
frequent in women 30 to 39 year-old. Endometriosis was minimal in 16        4% and 4% respectively). In addition, no significant differences of the
cases (33.3%), mild in 12 (25%), moderate in 11(22.9%) and severe in 9      factor allelic loss (FAL) were observed between the stages II, III and IV
cases (187%), including 7 cases of endometriomas. Most frequent             of the disease. In conclusion, we found that loss of heterozygosity on
endometriosis sites were posterior cul-de-sac, ovaries and uterosacral      p16Ink4, GALT and p53, as well as on APOA2, a region frequently lost
ligaments. Both chronic salpingitis and pelvic adhesions were               in ovarian cancer, occurs in endometriosis and were seen even on stage
coincidental findings in 62.5% (30 cases) and 43.7% (21 cases),             II of the disease. The occurrence of such genomic alterations may
respectively. Fulguration of endometriosis foci and removal of              represent important events in the development of endometriosis.
endometriomas were performed as welt as lysis of adhesions and
restitution of Fallopian tubes functional anatomy when indicated,
Conclusion: There is a high frequency of endometriosis in Peruvian          FC1.18.04
women with infertility or recurrent abortion.                               A NUDE MICE MODEL FOR THE INVESTIGATION OF
                                                                            PERITONEAL ENDOMETRIOSIS
                                                                            P.-A. Regidor (1), K. Bainczyk (2), H. Hess-Stumpp (3), R. Grummer
FC1.18.02                                                                   (2), E. Winterhager (2), A.E. Schindler (1)
ESTROGEN RECEPTOR EXPRESSION IN ADENOMYOSIS- DOES                           (1) Dept. of Gynaecology, University of Essen, Essen, Germany.
IT SHED A LIGHT ON PATHOGENESIS?                                            (2) Institute of Anatomy, University of Essen, Essen, Germany.
Sr.T.Lillian* and Karuna Rameshkumar                                        (3) Schering AG Germany, Berlin, German.
* Department of Obstetrics and Gynaecology, St.Philomena’s Hospital,
 Department of Pathology, St.John’s Medical College, Bangalore, India       Objectives: As the current therapeutical approaches in the treatment of
                                                                            endometriosis are still associated with high recurrency rates, new in vivo
Background: Adenomyosis is a relatively frequent endomyometrial             models have to be developed for the future treatment of this disease. The
pathology discovered in multiparous women between 40 and 50 years of        aim of our study was therefore to establish a functioning nude mice
age. Epidemiology and symptomatology of the condition has been              model for the cultivation of human endometrium that allows the
characterised extensively, but the estrogen receptor(ER) content in         investigation of drug effects on it.
adenomyosis has received scant attention in comparison to                   Study Methods: Human endometrium of untreated premenopausal
endometriosis.                                                              women was used in this study. The endometrium samples were stored in
Objectives: To evaluate the clinical features and light microscopy          DMEM/F12/FCS solution before being implanted in the nude mice. The
findings and to correlate the results with                                  nude mice used belonged to the species Han NMRI/nu/nu. 28 animals,
immunohistochemical studies to analyse the possible pathogenesis.           of whom 13 were regularly cycling mice, 7 were oophorectomiced and
Material and methods: A retrospective analysis of 3725 hysterectomies       received no estradiol replacement, and the remaining 8 were also
was done over a period of twenty years in a tertiary hospital to analyse    oophorectomiced but received an estradiol replacement of 0.2mg
the clinical features and light microscopy findings.ER content was          estradiol subcutaneously per day, were used in this investigation. The
studied and quantitated by immunohistochemistry and compared to ER          animals were operated again between 2 and 21 days after the
content of surface endometium in different phases of menstrual cycle.       implantation of the endometrium samples.
Results: An incidence of 34.4 % adenomyosis was observed with peak          Results: We could cultivate endometrium samples till 21 days after
incidence in the fifth decade.Correlation of symptoms and estrogen          implantation. The best results were observed in the group of animals
receptor expression between functional state of surface endometrium         with regular cycling and in the E2 substituated oophorectomiced group.
and adenomyotic foci showed the former to have a significant                In the oophorectomiced and not E2 substituated group of animals only a
correlation. The adenomyotic foci showed the presence of estrogen           low development of endometrium implants could be observed. The
receptors, irrespective of the phase of the surface endometrium.            implants did adhere after 2 days especially on the peritoneal surface and
Conclusions: Smooth muscle hyperplasia and hypertrophy seen in              on the intestine. After 14 days angiogenesis was observed and the
adenomyosis at light microscopy may be a reactive change, secondary to      implants developed an invasive potency.
ectopic endometrial proliferation. The association of other lesions such    Conclusions: This is one of the first models describing the ability of
as fibroids(34.5%) pelvic and ovarian endometriosis (7.2% and 5.5%)         human endometrium to attach and invade extraperitoneal structures such
48                                                                                                                       MONDAY, SEPTEMBER 4

as the peritoneum. With this model, good differenciated endometrium           (51%) pedigrees. However, some heterogeneity in these families exists:
tissues could be obtained even 21 days after implantation. With this          not everyone endometriosis patient in arthalgia families had symptoms.
model, new drugs as gestagens, anti-estrogens or angiogenetic inhibitors      On the other hand some family members had arthalgia some
can be easily tested out to try to develop new strategies in the              endometriosis.
management of endometriosis.                                                  Conclusions. Our results suggest that there is some susceptibility genes
                                                                              leading to endometriosis. The expression of these genes may vary and
                                                                              the clinical symptoms differ between individuals. These results signify
FC1.18.05                                                                     the importance of further studies on the role of matrix
ENDOMETRIOSIS MAY ADVERSELY AFFECTS ENDOMETRIAL                               metalloproteinases in the development of endometriosis and arthritis.
D.J. Cho, S.K. Kim, D.W. Park, H.C. Kwon1, OB/GYN, Yonsei                     FC1.18.07
University College of Medicine, 1Eulji University School of Medicine,         ALTERED PROLACTIN SECRETION AFTER DOPAMINERGIC
Seoul, Korea                                                                  BLOCKADE IN INFERTILE PATIENTS WITH ENDOMETRIOSIS
                                                                              J.S. Cunha-Filho, Porto Alegre, Brazil.
Objectives: Endometriosis is a common cause of dysmenorrhea and
infertility. However, the mechanisms of the infertility remain unclear.       Objectives: To investigate the onset of a subtle prolactin alteration after
Endometriosis, even in mild forms, may alter folliculogenesis or              dopaminergic blockade by metoclopramide in infertile patients with
ovulation, and/or adversely affect luteal phase function, ovum transport,     endometriosis.
sperm quality and function, fertilization and embryo quality. The             Design: Cross-sectional controlled study
association between endometriosis and implantation defects have               Setting: Tertiary care center clinic.
recently been suggested as one of key field to investigate. We compared       Patients: Twenty-six women participated in the study: nine fertile
the expression pattern of biological markers of implantation and tissue       patients who underwent tubal ligation; and 17 infertile endometriotic
remodelling in in-phased endomerium of patients with endometriosis            patients undergoing infertility investigation (13 with minimal or mild
and control subjects to prove the occult defect in uterine receptivity in     endometriosis; four with moderate or severe endometriosis).
cases of endometriosis.                                                       Intervention: Patients were submitted to laparoscopy. Blood samples
Study methods: Endometrial tissues were obtained from the normal              were collected in the beginning of follicular phase of the menstrual cycle
subjects (group 1; n = 20) and patients with endometriosis (group 2; n =      for analysis of prolactin secretion Dopaminergic blockade was achieved
25) during the expected implantation window. The endometrial dating           with 10 mg of metoclopramide administered with a venous catheter.
by converntional criteria confirmed the appropreate timing of the             Samples were collected at 15 minute intervals (0,15, 30, 45, 60 minutes).
sampling. The expression patterns of progesterone receptor, integrin _3,,     The secretion pattern of serum prolactin before and after dopaminergic
and cyclooxygenase-2 were analysed by immunohistochemistry and                blockade was compared.
western blot.                                                                 Main Outcome Measure: Post-blockade serum prolactin levels.
Results: In group 2, the nuclear progesterone receptor expression was         Results: Infertile endometriotic patients presented altered prolactin
significantly elevated in glandular epithelial cells (p<0.05). The integrin   secretion 30 minutes after dopaminergic blockade. Altered secretion
_3 expression was significantly decreased in epithelial and stromal cells     occurred mostly among moderate or severe endometriosis patients.
compared to group 1 (p<0.05). In western blotting, cyclooxygenase-2           Conclusions: Dopaminergic blockade revealed an occult
expression was significantly increased in group 2, which was more             hyperprolactinemia in infertile women with endometriosis, which may
distinct in stromal cells (p<0.05).                                           contribute to infertility. Our results suggest a relation between altered
Conclusions: These results suggest that immunohistochemical study for         prolactin secretion and endometriosis-caused infertility.
biochemical markers can detect occult impairement of endometrial
receptivity. It also can be a useful supplement to conventional dating to
assess endometrial maturation. We conclude that these biochemical             FC1.18.08
markers may be a clue to elucidate relation between endometriosis and         CALCIUM AND APOPTOSIS IN ECTOPIC ENDOMETRIUM: A
abnormal implantation.                                                        POSSIBLE CONNECTION
                                                                              L. Radzetskaya, O. Miadelets, S. Zolotuchina, L. Suprun, Dept.
                                                                              OB.GYN, Vitebsk Medical University, Vitebesk, Belarus
IS HEREDITARY ENDOMETRIOSIS ASSOCIATED WITH                                   Objectives: The aim of this study was to investigate an accumulation of
RHEUMATOID ARTHRITIS LIKE ARTHALGIA?                                          calcium in cells of foci of adenomyosis.
Perheentupa A, Saranen O, Heinonen S, Martikainen H, Peltonen L*,             Study Methods: We carried out a histological examination of 19
Ryynänen M, Departments of Obstetrics and Gynecology, Oulu                    hysterectomy specimens with adenomyosis and 13 ones with
University Hospital and Gonda Neuroscience and Genetics Research              leiomyoma. We used the alizarin red S staining for reveling calcium.
Center, Los Angeles, California, USA*                                         Results: In foci of adenomyosis, a lot of arterioles were contracted,
                                                                              capillaries, precapillarian sphincters and capillary veins were as a rule
Objectives. Endometriosis markedly disrupts physical and emotional            enlarged. The framework was infiltrated by lymphocytes and
well being in many women. It is one of the most prevalent disorders in        macrophages. Full-blooded microvascular vessels, diapedesis of
gynecology and causes lower abdominal pain as well as infertility.            erythrocytes and hemorrhages were registered. Calcium was found to be
Endometriosis, the presence of functional endometrium in ectopic              increased in myocytes including microvascular ones, in fibroblasts of the
locations, is a benign metastatic disease in which the same processes as      connective tissue, glandular cells and sometimes in erythrocytes. The
in metastasis may play an important role. The endometrial cells must          nucleuses were intensively saturated with calcium too. The level of
attach and invade a new environment, proliferate and establish blood          calcium in the adenomyosis cells was irregular. There was a significant
supply. In order for these pathological processes to occur successfully       difference in the amount of apoptotic cells in various patients. It
the environment must cooperate. This means dysfunction of the                 correlated with the level of calcium accumulation. The cells with a high
environment. Candidate factors involved in the inhibition and                 level of calcium accumulation were rare to be found in the state of
occurrence of endometriosis include matrix metalloproteinases (MMPs),         apoptosis. The incidence of apoptotic bodies in ectopic glandular sells
cytokines, angiogenetic and other growth factors.                             with a low level of calcium accumulation was significantly higher.
Study methods. 118 consecutive patients with surgically verified              Conclusions: The disturbance of intracellular calcium accumulation may
endometriosis were interviewed at Oulu University Hospital during the         have a significant effect on the development and progression of
year of 1999. In 24 cases (20.3%) endometriosis was verified also in two      adenomyosis as a possible regulator of apoptosis in ectopic endometrium
or more close relatives. In addition, 29 cases of hereditary endometriosis    and of myocyte contraction in foci of adenomyosis.
were collected from hospital records, infertility unit and private clinics.
A detailed history of associated diseases was acquired.
Results. There were 121 verified and 28 clinically suspected (not
surgically verified) endometriosis cases in the families studied. Arthalgia
(like rheumatoid arthritis with negative rheum factor) were found in 27
MONDAY, SEPTEMBER 4                                                                                                                                    49

FC1.18.09                                                                     Conclusions: The described operating technique is a well-proved and
TREATMENT OF ENDOMETRIOSIS AS A PRIORITY BEFORE                               safe method for nearly all cases of reduction mammoplasty because of
ART                                                                           breast hyperplasia. It is suited for nearly all resection volumes (from 200
A. Saremi, Dept. of infertility, Sarem Medical Center, Tehran, Iran           to 3600g) and also useful for long elevation distances of the areola-
                                                                              nipple-complex up to 21 cm. By a correct and well-proved indication,
Objectives: Endometriosis is a prevalent gynecological symptom in             our method of craniomedical pedicle has a very low complication rate.
woman of reproductive age and it is usually detected during infertility
work up. Even though there are many studies indicating the relation
between endometriosis and infertility, the clear relation between             FC1.19.02
minimal and mild endometriosis and infertility is not yet available. Since    THE ROLE OF ENZYME-LINKED IMMUNOSORPTION ASSAY
the main mechanism to prove that endometriosis is a cause of infertility      (ELISA) IN DIAGNOSING AND ASSESSING THE PROGNOSIS OF
is not known, an effective treatment approach for endometriosis               BREAST CANCER.
associated infertility has not been introduced. The purpose of this study     G.Barrenetxea(*), F.Llorente(**), J.Genollá(**), B.Eizaguirre(***),
is to evaluate the effectiveness of medical treatment or laparoscopy or       C.Osuna(*), F.J.Rodríguez-Escudero(*)
exerting both treatments to increase successful pregnancy in these            (*) Departamento de Ginecología y Obstetricia; (**) Servicio de
patients.                                                                     Medicina Nuclear: (***) Servicio de Anatomía Patológica. Hospital de
Study Methods: A historical controlled retrospective analysis was             Cruces. Universidad del País Vasco/EHU. Bilbao. SPAIN.
performed from April 1996 till 1998 in Sarem Medical Center, on 326
infertile women with endometriosis who underwent approved                     Background: An expanded understanding of the biology of breast cancer
laporoscopy. The mean age of these patients was 30 (range 19-46).             has led to the identification of the HER-2 receptor as an important
Their endometriosis stages were classified according to revised               growth factor. This protein has been associated with aggressive
American Society for Reproduction. Patients were treated for 3 to 6           biological behaviour and poor clinical outcome.
months following their classification, using long acting GnRha or             Objectives: The aim of the study was to investigate the predictive value
medical and laparoscopy treatment or laparoscory electrosurgery via           (breast cancer prediction) of the determination of circulating levels of
coagulating superficial endometriosis by bipolar forceps during               HER2 protein among patients undergoing breast biopsy.
laparoscopy. Deep implants using unipolar cautery was also carried out,
then depending on the results obtained from infertility work up, ART is       Study Methods: Serum samples of 575 women attending the breast
performed. 100 women with mild or moderate endometriosis underwent            cancer unit of Hospital de Cruces (Spain) between August 1993 and
ART before any kind of treatment. The pregnancy rate of the above             December 1996 were evaluated. Samples were preserved a –70º C and
groups were compared with each other and the obtained results were            processed by an enzyme-linked immunosorption assay (ELISA) using a
analyzed using students T-test.                                               monoclonal antibody of Bender MedSystemsÒ. The intra and inter-assay
Results: 18 pregnancies (16.07%) resulted from patients who underwent         variability coefficient was of 1.9% and 5.8% respectively. HER2 serum
medical treatment, only one case ended up with an abortion. In the group      determination has been considered both as quantitative and dicotomic
dealing with medical and laparoscopy treatment, 29 pregnancies                (negative/positive) variable.
(18.95%) occurred. In the group that was subjected to laparoscopy, 10         Taking into account the asymmetric distribution of values, descriptive
pregnancies (16.39%) took place. In the untreated group followed by           statistical analysis was performed using the average, 25, 75 and 95
ART the pregnancy rate was 8%. Median interval between treatment              percentile, and intercuartil wide (IW) or the difference between P25 and
period and successful pregnancy was 12.3 months. Among the three              P75. The comparisons were analysed using Pearson’s c2 test (between
treated groups studied, a significant difference concerning pregnancy         qualitative variables), non-parametric Mann-Whitney and Kruskal-
rate was not seen, but a significant difference in pregnancy between the      Wallis assays (between qualitative and quantitative variables) and
treated and non-treated group was noted.                                      correlation analysis (between quantitative variables).
Conclusion: No significant difference was observed in the pregnancy           Design
rate of infertile women with endometriosis who underwent medical or           Cohort analysis
laparoscopy treatment. Thus it seems that women with endometriosis            Results
benefit better following treatment.                                           Among 575 women evaluated, 205 (35.7%) were diagnosed of benign
                                                                              pathology, 24 (4.2%) of in situ carcinoma and 346 (60.2%) of
                                                                              infiltrating carcinoma. The average values (ng/ml) were the following:
FC1.19 BREAST CANCER                                                                                    N Average P25            P75     IW P95
                                                                              Benign pathology         205      3.2      2.6      4.4    1.8 10.6
FC1.19.01                                                                     In situ carcinoma         24      3.2      2.6      5.4    2.8 28.8
REDUCTION MAMMAPLASTY USING A MODIFICATION OF                                 Infiltrating carcinoma 346        3.6      2.6      5.0    2.4 14.1
THE STROEMBECK-METHOD                                                         A 7.9% of breast cancer patients without metastases and a 33.3% of
U. Retzke, U. Rhein, H. Graf, R. Illing, Dept. OB/GYN,                        metastatic breast cancer patients showed pathologic values (p=0.000).
Zentralklinikum Hospital, Sudthuringen, Shul, Germany                         Moreover, progression of the disease was associated with pretherapeutic
                                                                              pathologic HER2 values (16.4%; p=0.000).
Objectives: In our department OB/GYN, we performed (until 1999)               Conclusions: The serum determination of HER2 does not differentiate
more than 500 reduction mammaplasties. Since 1994, we used a special          benign and malignant breast pathology. However, there is a positive and
technique of craniomedial pedicle as an own modification of the original      independent association between elevated serum HER levels and a poor
Stroembeck-method. The purpose of this study was to compare our               prognosis (shorter disease free and overall survival) in breast cancer
method of reduction mammaplasty with the international widespread             patients.
method of McKissock.
Study Methods: Between 1997 and 1998, we performed 153
mammoplastic procedures. All cases were checked retrospectively for           FC1.19.03
resection volume, blood loss, duration of the operation, surgical             LIPOSUCTION: A NOVEL TECHNIQUE FOR BREAST
complications, aesthetic deviations of the different techniques and for       REDUCTION
satisfaction of the patients by questionnaire and personal interview.         M. Artiga (1), O. Carpio (2)
Results: During two years, we performed 151 surgical procedures with          (1) Dept. Gynecology/Mastology, National Maternity Hospital, San
the technique of craniomedial pedicle or with McKissock method. In                Salvador, El Salvador.
summary, the described surgical technique of craniomedial pedicle as          (2) Dept. Dermatologic Surgery, Zacamil Hospital, San Salvador, El
our modification of the Stroembeck-method is more improved                        Salvador.
concerning blood loss, duration of the operation, surgical complications,
aesthetic valuation and satisfaction of the patient. After the operation,     Objectives: The aim of the study was to demonstrate that liposuction by
there is also a statistically significant better rate of breast-feeding and   the Tumescent Technique (LTT) is a good alternative for breast
maintained sensibility of the areola-nipple-complex compared with the         reduction (BR) in women with breast hypertrophy due to lipomatosus
technique of McKissock.                                                       tissue (BHLT).
50                                                                                                                     MONDAY, SEPTEMBER 4

Study Method: During a six-month period (July – December, 1999) five         FC1.19.06
patients were included in this prospective study. They have had either a     CHEMORESISTANCE AND GENE EXPRESSION IN BREAST
mammography or ultrasound showing no malignancy and BHLT.                    CANCER CELLS
Results: The five patients who underwent this procedure lost between         Joachim Volz, Stefanie Volz-Köster, Johannes Frühauf, Jürgen Bach
600 and 1200cc of fatty tissue per breast, their brassier size had in        Dept. of Obstetrics and Gynecology, Klinikum Mannheim, Faculty of
promedia two size cup reduction. No blood transfusion was needed. All        Clinical Medicine of the University of Heidelberg
patients are very satisfied with their results. There were no
complications.                                                               Objectives To study molecular aspects of chemoresistance in breast
Conclusion: Liposuction by Tumescent Technique was found to be a             cancer.
secure and effective method for patients with breast hypertrophy due to      Study Methods mcf7-and T47D- breast cancer cells were treated with
lipomatosus pattern.                                                         different chemotherapeutics. To simulate the clinical situation, at least
                                                                             three weekly cycles of treatment with different chemotherapeutics were
                                                                             performed. Chemoresistance of surviving cells is demonstrated by
FC1.19.04                                                                    performance of cytotoxicity assays in comparison to the sensitive
CORRELATION OF MAMMOGRAPHIC AND SONOGRAPHIC                                  parental cell lines (decreased propidium iodide staining after treatment,
FINDINGS IN BREAST EXAMINATION                                               enhanced
Eva Visca1, W. Holzgreve1, Ulrike Otto2, G. Feichter3, Sevgi Tercanli1       ATP-levels in resistant cells after treatment).To better understand the
  Dept. OB/GYN, 2Dept. Radiology, 3Dept. Pathology, University               cellular aspects of chemoresistance gene expresssion is to be analysed
Hospital Basel, 4031 Basel, Switzerland                                      using cDNA arrays. mRNA´s from chemoresistant cells as well as from
                                                                             untreated cells are isolated and hybridised to an array. Expression levels
Objectives: Mammographic findings are classified using the American          of more than 50.000 genes are monitored in chemoresistant cell lines
College of Radiology Breast Imaging Reporting and Data System (BI-           and compared to expression levels from untreated, chemosensitive mcf7-
RADS). In analogy, we developed sonographic scoring categories 0 to 5        and T47D-cells.
for breast ultrasound. The aim of the study was to analyze the               Results Six chemoresistant breast cancer cell lines were generated. By
correlation between the two scoring systems.                                 performing cytotoxicity assays, chemoresistant cells demonstrating a
Study Methods: Retrospective analysis of 1547 patients who underwent         reduced sensitivity to cytotoxic compounds. Using cDNA microarrays
mammographic (MG) and sonographic (US) scanning in the years 1998-           distinct alterations in gene expression are monitored. Expression profile
1999.                                                                        differs analogue to resistance mechanism induced by different
Results: Overall correlation between MG and US categories was poor, as       chemotherapeutic agents.
sonographically undetectable calcifications led to differing MG              Conclusion It is anticipated that a better understanding of
categorization. In breast lesions classified as moderately to highly         chemoresistance on themolecular level will help to avoid, treat or early
suspicious (categories 0, 4 and 5) correlation between the two               detect chemoresistance in breast cancer patients.
investigations was highly significant (p<0.001). An US score of 4/5 was
confirmed by MG in 75.6 % or required further investigation (BI-RADS
category 0) in 19.5 %.                                                       FC1.19.07
Conclusions: Mammography is a well established screening method.             A NEW COMPUTER BASED SCORING SYSTEM FOR
Breast US provides supplementary information, especially in those cases      CHARACTERIZATION OF BREAST LESIONS
where malignancy is suspected. We recommend US screening in high             A. Mundinger1, H. Madjar2, X. Papacharalampous3, M. Butterwegge4 ;
risk patients.                                                               Dep. Radiology1, DKG Wiesbaden2, University of Athens3, Dep.
                                                                             OB/GYN4, Marienhospital Osnabrueck, Johannisfreiheit 2-4, 49074
                                                                             Osnabrueck, Germany.
THE ROLE OF ULTRASOUND-GUIDED CORE BIOPSY IN                                 Objectives : To develop a new scoring system for better distinction of
EVALUATION OF SUSPICIOUS BREAST LESIONS                                      benignity or malignancy in breast lesions.
C. Wilke, L. Schmitt, I. Schreer, W. Jonat, Dept. OB/GYN, University         Study Methods : In 279 patients with histologically proven malignant
Hospital, Kiel, Germany                                                      lesions (including 52% CIS or T1, 34% T2) and 261 patients with
                                                                             proven benign findings the presence or absence of 39 clinical,
Objectives: By recent improvement of ultrasound we see more                  sonographical and mammographic criteria was assessed. All data were
sonographically suspicious breast lesions. The aim of the study was to       introduced in a statistical logistic model to analyze the weighted
get histologically proved diagnosis by ultrasound-guided core biopsy         diagnostic impact of each criteria and to establish a corresponding score.
and to investigate the quality of this method.                               ROC analysis was performed to define the optimal threshold to
Study Methods: From June 1996 to November 1998 we performed 348              malignancy.
ultrasound-guided core biopsies of suspicious breast lesions. Women          Results : The combination of 5 clinical, 4 sonographical and 4
ranged in age from 19 to 96 years (mean, 54 years). For biopsies in local    mammographic findings yielded a higher accuracy (93%) than
anaesthesia we used 13-gauge coaxial needles and an automated core           preoperative intuitive diagnosis (82%). Irregular margins of a
biopsy gun (BIP) in conjunction with 14-gauge needles. The puncture          sonographic lesions (3 points), mammographically grouped
was guided in free-hand technique by a linear ultrasound probe               microcalcifications, starlike architectural distorsion and spicula (each 2
(PICKER, 7.5 MHz resp. ATL, 5-10 MHz). The size of the lesions               points) were discriminating imaging findings. 95,3 % and 98,5 % of
ranged from 0.5 to 12 cm (main 2-3 cm).                                      patients with malignancies, as well as 31,4% and 57,1% with benign
Results: Histopathological findings were 222 cancer (161 ductal              lesions, presented with 4 or more points and 3 or more points
invasive, 34 lobular invasive, 23 other invasive and 4 intraductal), 54      respectively.
fibroadenomas, 46 fibrocystic changes, 7 mastitic changes and 19 other       Conclusions : The presented scoring system which involves the use of
benign entities. 38 women got a primary chemotherapy, 8 a hormone            precise and objective terms facilitates the evaluation of existing and
treatment. 213 patients in all underwent surgical excisional biopsy in our   newly developed lesions. It has been proven to be a valuable new tool in
clinic, 195 of them with cancer. All malignant core biopsies were            the preoperative evaluation of patients being considered for biopsy,
confirmed. In one case of atypical ductal hyperplasia by core biopsy the     segmental lumpectomy or mastectomy.
open surgical procedure showed invasive cancer and DCIS.
Conclusions: Regarding the one case of disagreement the needle biopsy
had a sensitivity of 99.5% and a specificity of 100%. The ultrasound-
guided core biopsy is a valuable and safe method in diagnosis and
therapy planning, above all for advanced breast cancer.
MONDAY, SEPTEMBER 4                                                                                                                                  51

FC1.19.08                                                                    Results : The only parameter significantly different between the two
MODIFIED RADICAL MASTECTOMY USING THE HARMONIC                               groups was parity (higher in the trial of scar group).
SCALPEL.                                                                     Conclusion : Patient profiling cannot identify those women requesting
P. Bratila, O. Nicodin, N. Niculescu, Gynecologic Clinics, Central           elective repeat caesarean section. Thus health education should target all
Military Hospital of Bucharest, Romania                                      women who have had one previous caesarean section for a non recurrent
Objective: To evalaute the advantages of using the harmonic scalpel as a
replacement for convectional electro-cautery tools in mastectomy cases.
Materials and Methods: From 1999-2000 we compared 23 women                   FC1.20.02
undergoing masterectomy using the ultrasicion (Ethicon Endosurgery)          VAGINAL BIRTH AFTER CAESAREAN SECTION
scalpel to 54 women in whom the mastectomy was performed with                V.Madhini, S.Gorthi, Government RSRM Hospital, Cemetry road,
conventional mono or bi-polar cautery. The mean age of the patients was      Royapuram, Chennai, Tamil nadu, India, 600 013.
52.8 years and both arms of the study contained an equal percentage of
women with a history of pre-operative radiation treatement (12 in the        Objective : Aim is to study the feasiblity of Vaginal Birth after
ultracision and 24 in the electro-cautery group).                            Caesarean section without electronic fetal monitoring and measurement
Results: When the ultracision harmonic scalpel was used we noted             of Intrauterine pressure.
reduced intra-operative blood loss, less post-intraoperative injury to the   Study Method: Two thousand nine hundred and sixty pregnant women -
associated lymphatic system, less post-operative morbidity and shorter       post caesarean pregnancy were included in this retrospective study and it
hospital stay.                                                               was conducted at Government RSRM hospital,Chennai from January
Conclusions: Our results lead us to believe that using the harmonic          1997 to December 1998
scalpel as the main dissection tool during breast surgery may have           Results : During the study period there were 22,855 deliveries among
numerous intra and post operative benefits                                   them 4824 women were delivered caesarean section -- 23.65 % .Two
                                                                             thousand nine hundred sixty women were post caesarean pregnancy and
                                                                             2176 women were allowed for trial of vaginal delivery.Seven hundred
FC1.19.09                                                                    and eighty four women were taken up for repeat elective caesarean
RESULT OF BREAST CANCER AFTER                                                vaginal delivery occured in 42.33% and 57.67% underwent emergency
HYPERTHERMOTHERAPY                                                           repeat caesarean section.Theses women were monitored by Pinards
L. Liu, Q. Sun, Tianjin 2nd Central Hospital, Tianjin, China.                fetoscope and clinical examination only.Incidence of scar rupture was
                                                                             0.8% and perinatal mortality was 30/1000 compared to the perinatal
Objective: The aim of this paper is to study the effect of hyperthermia on   mortality of 45/1000 during the study.
the treatment of breast cancer.                                              Conclusion : Vaginal delivery following caesarean section can be safely
Study Methods: There were 20 patients in this group, all females, aged       undertaken in hospitals in developing countries where electronic fetal
41-64. The sizes of the tumors by palpation ranged from 0.6x0.7 to 4x5       monitoring and intrauterine pressure measurement are not possible.With
cm. They were diagnosed by needle biopsy: invasive cancer 11 and non-        close vigilant clinical monitoring Vaginal birth after caesarean is a safe
invasive cancer 9. All patients were treated with a set of microwave         option.
therapy of 2450 MHz. The radiator was circular with a diameter of 10
cm. It was set at 3 cm away the skin. The temperature was kept at 44-
45°C for a duration of 30 min for every other day and for ten times in       FC1.20.03
total. All operative resection was carried out with one week after the       TERM BREECH TRIAL (TBT): A RANDOMISED CONTROLLED
tenth therapy. The tumors were sent to the laboratory for pathological       TRIAL (RCT) OF PLANNED CAESAREAN SECTION (CS) VS
examination.                                                                 PLANNED VAGINAL BIRTH (VB) FOR BREECH AT TERM.
Results: The sizes of the tumors changed after treatment: 3 complete         M.E. Hannah, W. Hannah, for the TBT Group, University of Toronto,
regression, 14 partial regression, 3 no change. The pathological changes:    ON, Canada. Funded by MRC, Canada.
in 3 cases, cancer cells cannot be found. The changes of cancer cell were
granular and vascular degeneration, cytolysis, cytopyknosis, karyolysis      Objectives: This multicentre, international RCT will recruit 2800 women
and karyopyknosis. Interstitial changes were fibroplasia and infiltration    to compare planned CS vs planned VB for the term breech fetus.
of inflammatory cells. The ultrastructure changes after treatment: the       Participating centres must ensure that patients having a VB have an
cell membrane is not clear, the interstitial spaces are widened and with     experienced and skilled clinician at delivery.
oil droplets, the mitochondria showed agglutinated type of degeneration.     Study methods: To be eligible there must be a frank or complete breech
Conclusion: It was found that breast cancer can be reduced, even             presentation at ³37 weeks, no evidence of fetopelvic disproportion or a
eliminated by hyperthermotherapy and the damaging and curative               hyperextended fetal head, and a singleton live fetus. Those with EFW
effects of both hyperthermia and radiotherapy were similar. Superficial      ³4000g, contraindications to labour or VB, or lethal congenital anomaly
tumor was more sensitive than profound tumor to hyperthermia. The            are excluded. The principal outcomes are perinatal/neonatal mortality
safety of applying hyperthermotherapy was proven by the fact that there      &/or serious morbidity, and serious maternal complications. Other
were no serious effects on hemopoietic function and other systems.           outcomes include: postpartum depression, pain, urinary and faecal
                                                                             incontinence, sexual relations and relationship with partner, satisfaction
                                                                             with the birth experience, and breast feeding at 3 months and 2 years
FC1.20 CESAREAN SECTION 2                                                    postpartum, and infant neurodevelopmental status at 2 years.
                                                                             Results: As of January 24, 2000, 1884 women from 100 centres have
FC1.20.01                                                                    enrolled in the study. Compliance with mode of delivery has been
CAN PATIENT PROFILING IDENTIFY THOSE WHO REQUEST                             excellent. As of January 1, 2000 the CS rate in the planned CS group
AN ELECTIVE REPEAT CAESAREAN SECTION?                                        was 90%, and the VB rate in the planned VB group was 56.5%. The
L.M.Irvine (1), R.W.Shaw (2), (1) Watford General Hospital, Vicarage         Data Monitoring Committee reviewed the data after 1000 women were
Road, Watford, Hertfordshire, United Kingdom, WD1 8HB, (2) Heath             enrolled and recommended that the study continue as planned.
Hospital, Cardiff, Wales, UK.                                                Participating countries include Canada, UK, Finland, India, South
                                                                             Africa, Chile, Australia, Israel, Argentina, Switzerland, USA, Denmark,
Objectives : Maternal request for elective repeat caesarean section is       Germany, Pakistan, Mexico, Poland, Yugoslavia, Jordan, Brazil,
being seen more frequently in obstetric practice in the United Kingdom.      Zimbabwe, Romania, Egypt, Portugal, The Netherlands, and New
Is it possible by patient profiling to identify such women? If so health     Zealand. Other interested centres should contact TBT c/o MIRU (fax: 1-
education could be targeted at these patients.                               416-351-8131; email:
Study methods: A study of all women booked for delivery between
1/1/96 to 31/12/97 was undertaken. The obstetric records were reviewed
of 171 women who underwent trial of scar, and 165 who requested
repeat caesarean section. Data was extracted on age, parity, social class,
place of previous delivery and whether performed as an elective or
emergency procedure.
52                                                                                                                         MONDAY, SEPTEMBER 4

FC1.20.04                                                                      structures when wishes instead of medical indication guide medical
LABOR TRIAL IN PATIENTS WITH PRIOR CESAREA                                     interventions.
D. Vasquez-Awad, E. Forero, W. Rubiano, Dept. OB/GYN, Samaritana               Study Methods: One thousand women delivering their babies at the
University Hospital, Bogota, Colombia.                                         General Hospital in Salzburg were included in this study. They were
                                                                               screened for a wish for a cesarean section (half-structured interviews)
Objectives: Surgical birth via cesarean delivery is the most common            without a medical indication on the background of their obstetrical
major surgical intervention practiced. Such an increase can be explained       history, present situation as well as their being cared for during
by many factors, among with legal issues, improvements in fetal                pregnancy (by gynecologists and midwives).
medicine, economic factors and the right surgeons arranging their              Results: Only 5% of the women interviewed, exactly 50 out of 1,000
schedules with their personal lives. Nevertheless, labor trial in patients     women, raised a wish for a cesarean section during the ongoing delivery.
with prior cesarean deliveries can dramatically decrease the number of         Their wishes were taken seriously into account by physicians and
cesarean sections.                                                             midwives when deciding about the method of the delivery. Their wishes
Study Methods: This is a prospective study done at La Samaritana               were met by discussions, giving relief of pain by peridural anesthesia
University Hospital in Bogota, Colombia, covering a 10 year period (Jan        and the conditional preparation for the cesarean section in case the
1990 – Nov 1999) and included 843 patients with 1, 2, or 3 prior               woman would not be able to cope with continuation of the vaginal
cesareans.                                                                     delivery. She was the one to make the final decision.
Results: A total of 685 patients (81.64%) had vaginal delivery. 596            2.5% finally resulted in a vaginal delivery, 1.8% in a cesarean section.
patients had 1 prior surgical delivery, and vaginal delivery was               Concerning satisfaction with the method of giving birth all (except two)
successful in 502 (84.22%). 226 patients had 2 prior cesarean deliveries       wee finally content, admittedly under the perspective of healthy children
and vaginal delivery was successful in 174 (76.99%). 21 patients had 3         (none of them was severely affected).
prior cesarean deliveries and vaginal delivery was accomplished in 9           Conclusion: The discussion raised in Austria about cesarean section on
(42.85%).                                                                      mere demand of the pregnant women (according to autonomy principle)
Oxitocin was liberally applied either for induction or reinforcement of        without any medical indication has nearly no point for women
an already ongoing labor as well as regional analgesia.                        attentively cared for during pregnancy and ongoing delivery
The incidence of uterine rupture was 0.57%. No maternal mortality was          (beneficence principle).
observed and perinatal mortality rate didn’t exceed that of our general        The discussion only tends to undermine a medical system based on
population.                                                                    medical indications (“hard” as well as “weak” ones), that makes it that
Conclusions: With adequate patient selection plus permanent labor              way transparent and controllable for physicians as well as for patients. A
monitoring, vaginal delivery is a safe alternative in the obstetric care of    possible change of paradigm from a medicine based on medical
patients with prior cesareans.                                                 indications to one based on mere desire has to undergo a critical ethical

CESAREAN SECTION MORBIDITY AUDIT                                               FC1.20.07
Y.N. Reddy, D. Rajasekar, C. Lennox, Women & Children’s                        REDUCING CAESAREAN SECTIONRATE – ACTIVE
Directorate, Law Hospital Center, Carluke, Scotland                            MANAGEMENT
                                                                               M. Arbat, A. Ramkrishnan, Dept. OB/GYN, KRIMS Hospital,
Lower Segment Cesarean Section (LSCS) is common operative obstetric            Ramdaspeth, Nagpur, Maharastra, India.
procedure in Western maternity units and in some developing country
hospitals. Cesarean section rate can rise higher than an elective              Objectives: High Cesarean section rate in private hospitals is a major
episiotomy rate in some maternity units. In this information technology        controversial factor in India and claimed to be as high as 80 – 90%.
era, clients expect good quality, clear and accurate information about         Accepted Cesarean section rate is 15 – 20% in public hospitals, but
their health. The litigation fever among the providers and policy makers       varies with the type of patients attended by the center. Reduced maternal
is on the rise.                                                                and neonatal morbidity and mortality should be the aim for deciding the
Objectives: To compare local LSCS morbidity figures with National              mode of delivery. Our objective was to reduce Cesarean section rates to
figures and to develop Continuous Quality Improvement (CQI)                    absolute minimum by active management of patient.
strategies.                                                                    Study Methods: KRIMS HOSPITAL is a secondary and tertiary care
Study Method: Retrospective case notes review of all the LSCS carried          private setup for Obstetrics. Cesarean section rate over the last 7 years
out in South Lanarkshire Maternity unit in one year (1998).                    has been reduced from 40% to 20%. A critical evaluation of 100 patients
Results: Overall, LSCS morbidity in both elective and emergency                delivered was done with type of management, risk factors, indication of
procedures is 11% (26/241). This included febrile morbidity,                   Cesarean section and maternal and fetal outcome.
hemorraghic, viscus injury, infection and anaesthetic complications.           Active management included thorough antenatal work-up, after 35 – 36
Elective LSCS is safer than the emergency procedures, although in our          wks, close monitoring of fetal wellbeing with the help of USG and
settings, elective procedure are mostly carried out by senior obstetric and    Doppler and including the labor at appropriate time by membrane
anaesthetic consultants between 9 and 4 p.m. Bleeding morbidity is             separation, Oxytocin and Prostaglandin and ARM irrespective of risk
significantly increased after 12 midnight. This could be explained by the      factorsur. Epidural during labor was given where required.
fact that the labor ward staffs are not at the best of their efficiency. And   Results: Out of 20 patients who underwent C.S., only 2 had meconism
also, during odd hours, the LSCS are performed by junior obstetrician,         stained liquor and had given short trial of labor. 9 patients had sufficient
assisted by a midwife.                                                         trial of labor before labeling them as cephalo pelvic disproportion – 3
Conclusion: In our setting, LSCS appears to be a safe operation with           Elective C.S. were for previous C.S. with C.P.D., 2 for previous 2 C.S.,
minimal morbidity. Providing clear, concise local morbidity figures can        2 for Breech presentation, 1 for transverse lie and 1 for major placenta
improve the overall confidence of both users and the providers.                previa. No C.S. was for fetal distress. Fetal outcome was good in total
Continuous Quality Improvement strategies should be developed,                 sample.
evaluated and implemented.                                                     Conclusions: Active management of obstetric patients can reduce the
                                                                               C.S. rate to absolute minimum with good fetal outcome and reduce the
                                                                               strain of intra-partum fetal surveillance.
B. Maier, M. Lechner, G. Akmanlar-Hirscher, A. Staudach, Dept.
OB/GYN, General Hospital, Salzburg, Austria.

Objectives: The aim of the study was to investigate how often a wish for
a cesarean section without a medical indication occurs in women giving
birth. The purpose of the ethical inquiry about the results was to examine
the consequences for women concerned as well as for medicine’s
MONDAY, SEPTEMBER 4                                                                                                                                   53

FC1.20.08                                                                      FC1.21 CIN: LOW GRADE ABNORMALITIES AND
WHAT DOES THE FUTURE HOLD AFTER A CAESAREAN                                                PROGNOSTIC MARKERS
DELIVERY?                                                                      FC1.21.01
M. Whitten, Dept. OB/GYN, Watford General Hospital, Watford, U.K.              CLINICAL SIGNIFICANCE OF ATYPICAL SQUAMOUS CELLS
L. M. Irvine, Dept. OB/GYN, Watford General Hospital, Watford, U.K.            OF UNDETERMINED SIGNIFICANCE ON THINPREP PAP
Objectives: The aim of the study was to establish the effect of Caesarean      G.H. Eltabbakh(1), J.N. Lipman(1), S.L. Mount(2), A. Morgan(3),
section for failed trial of instrumental vaginal delivery on subsequent        (1) Division of Gynecologic Oncology,
pregnancies with respect to planning of mode of delivery and eventual          (2) Departments of Pathologym, and
outcome.                                                                       (3) Biostatistics
Study Methods: 698 women were included in the retrospective cross-             University of Vermont, Burlington, Vermont.
sectional study. All had previously undergone Caesarean section, and
had a subsequent delivery at Watford General Hospital within the study         Objective: To assess the incidence and risk factors predictive of
period of three years from January 1996 to December 1998. Previous             dysplasia among women with the cytologic diagnosis of atypical
failed trial of instrumental vaginal delivery accounted for forty-six of       squamous cells of undetermined significance (ASCUS) on Papanicolaou
these women. This subgroup was analysed by review of the patient               (Pap) smears obtained by the ThinPrep method among women seen on a
records to establish both the background to the previous delivery and the      gynecologic oncology service.
mode of delivery in the subsequent pregnancy.                                  Study Methods: Patients with ASCUS ThinPrep Pap smears seen at the
Results: In the overall study group, 42% underwent trial of scar,              Division of Gynecologic Oncology, University of Vermont between
compared to 20% of those where the previous Caesarean was for failed           1997 and 1999 were identified. The cytological smears were reviewed
trial of instrumental vaginal delivery. Of those attempting trial of scar,     and subtyped into reactive or suggestive of squamous intraepithelial
77% of the total group had a successful vaginal delivery, compared to          lesion (SIL). The charts of these patients were reviewed and the
only 55% in the subgroup. 34% of the total group underwent elective            following information abstracted: age, gravidity, parity, menopausal
repeat Caesarean section for maternal request, compared to 67% of the          status, use of hormonal replacement therapy, smoking, history of pelvic
subgroup.                                                                      cancer, history of radiation therapy, history of abnormal Pap smears or
Conclusions: Those attempting vaginal delivery following Caesarean             dysplasia, history of human papilloma virus (HPV) infection, and
section for failed trial of instrumental delivery have a lower likelihood of   follow-up information including results of repeat Pap smears,
successful vaginal delivery than for Caesarean delivery carried out for        colposcopy and biopsies. The incidence of dysplasia was calculated. The
other indications. A high proportion of these women will not wish to           demographic features of women with ASCUS, reactive were compared
attempt trial of vaginal delivery. Careful examination of the reasons for      with those with ASCUS, SIL, using two-sample t test, chi-square and
previous Caesarean section should help the patient and obstetrician            Fisher’s exact text. Risk factors predictive of dysplasia were calculated
decide on appropriate mode of delivery in subsequent pregnancies.              using the odds ratio and the 95% confidence interval. p<0.05 was
                                                                               considered significant.
                                                                               Results: 126 patients with ASCUS on ThinPrep Pap were identified: 63
FC1.20.09                                                                      patients had ASCUS, reactive and 63 patients had ASCUS, SIL. The
VIGINAL BIRTH AFTER CESARIAN DELIVER: VARIABLES                                demographic features of both groups were similar. The overall incidence
AFFECTING SUCCESS                                                              of dysplasia among the study patients was 15.9% and was significantly
V. Dadhwal, S. Mittal, S. Kumar, Dept. OB/GYN, All India Institute of          higher among women with ASCUS, SIL than among women with
Medical Sciences, New Delhi, India                                             ASCUS, reactive (25.4% versus 6.4%, p=0.003). Type of ASCUS
                                                                               cytology (reactive versus SIL), smoking, and history of HPV were
Objectives: To study the variables that may affect the success of vaginal      significant risk factors for dysplasia (p=0.003, 0.03. and 0.042,
birth after previous cesarean deliver (VBAC).                                  respectively).
Study Methods: In this retrospective study case records of 156 women           Conclusions: The incidence of dysplasia among women seen on a
with previous one cesarean who underwent trial of labor from January           gynecologic oncology service with ASCUS cytology on ThinPrep Pap
1996 to December 1997 were analyzed. Use of oxytocin, previous                 smears is 15.9%. Women with ASCUS favor SIL, those who smoke, and
vaginal deliver and indication of previous cesarean were studied as            those with history of HPV are at higher risk for dysplasia and should be
predictive factors for success. Note was made of uterine rupture and           offered colposcopy.
resulting maternal and perinatal morbidity and mortality. Data was
analyzed using normal test for proportion (Z=2, significant) or students
chisquare test (p<0.05, significant).                                          FC1.21.02
Results: 100 out of 156 women (64.1%) with previous cesarean delivery          HUMAN PAPILLOMAVIRUS TYPING IN THE MANAGEMENT OF
delivered vaginally. The variable that predicted successful outcome was        LOW-GRADE CERVICAL ABNORMALITIES
previous vaginal delivery (p<.001). Oxytocin was used for induction or         W.W. H. Li (1), M.Y.M. Chan (1), D.P.C. Chan (2), P.K.S. Chan (2)
augmentation of labor in 69 patients. There was no statistical difference      (1) Dept. OB/GYN, Queen Elizabeth Hospital, Kowloon, Hong Kong.
in the group who received oxytocin and that which did not require              (2) Dept. Microbiology, The Chinese University of Hong Kong, Prince
oxytocin (Z=1.57). The common indications for previous cesarean                of Wales Hospital, Shatin, Hong Kong.
section were fetal distress, breech and other malpresentations and non
progress of labor. There was no statistically significant difference in rate   Objectives: To evaluate the use of human papillomavirus typing to
of vaginal birth when different indications were compared. Four patients       predict the outcome of low-grade cervical abnormalities.
had uterine rupture. There was two neonatal deaths. There were no              Study Methods: HPV typing using consensus PCR coupled with RFLP
maternal deaths.                                                               were performed on women referred to the colposcopy clinic for
Conclusions: Previous vaginal delivery in women undergoing VBAC is             abnormal cervical smears. Women with colposcopic guided biopsy
a predictor of successful vaginal delivery. Use of oxytocin and                confirmed low-grade cervical lesions (condyloma or CIN I) were
indication of previous cesarean did not affect vaginal delivery rates.         recruited. They were managed conservatively by regular Papanicolaou
Careful fetal and maternal monitoring is required to reduce risk of            smear surveillance and HPV typing at 4 to 6 month intervals. Follow-up
uterine rupture.                                                               colposcopy was performed about 24 months later to assess the progress
                                                                               of the lesions. Earlier colposcopy would be arranged if the cervical
                                                                               smears showed progressive disease.
                                                                               Results: Results from 99 patients were analyzed. The mean follow-up
                                                                               duration was 22 months. Regression, persistence and progression of
                                                                               disease occurred in 39.4%, 49.5% and 11.1% respectively. While 48.9%
                                                                               of patients had no detectable HPV DNA, low-risk, and
                                                                               high/intermediate-risk HPV infections were detected in 9.1% and 34.3%
                                                                               of patients respectively. In those patients with no detectable HPV DNA
                                                                               at study entry, 2.1% had progressive disease. On the contrary, 26.5% of
54                                                                                                                        MONDAY, SEPTEMBER 4

patients with high/intermediate-risk HPV infection at study entry             those who chose colposcopy had significantly greater GHQ and
progressed. Further follow-up in those patients with persistent               Speilberger Anxiety State mean scores compared with those in the
high/intermediate-risk HPV infection, 58.3% progressed to high-grade          standard surveillance arm. However those women had a significant
lesions. The sensitivity, specificity, positive and negative predictive       reduction in scores compared with baseline following colposcopic
values of using persistent high/intermediate-risk HPV infections to           assessment.
predict progressive disease was 63.6%, 94.3%, 58.3% and 95.3%                 Final trial results will be presented.
respectively.                                                                 This trial is funded by the NHS R&D (Cancer) Programme.
Conclusion: Persistent high/intermediate-risk HPV infections may be
helpful in predicting progressive disease in those patients with low-grade
cervical abnormalities.                                                       FC1.21.05
                                                                              P53 POLYMORPHISM AND HIGHER SUSCEPTIBILITY TO
                                                                              CERVICAL NEOPLASIAS
FC1.21.03                                                                     T. Agorastos*, A.F. Lambropoulos**, T.C. Constantinidis***, A.
COLPOSCOPY AND BIOPSY OUTCOME OF CERVICAL SMEAR                               Kotsis**, D. Vavilis*, J.N. Bontis*
SUGGESTING LOW GRADE DISEASE - TIME TO CHANGE OUR                             *2nd Dept. OB/GYN, **Dept. Biology and Genetics and ***Dept.
REFERRAL POLICY                                                               Hygiene, Aristotle University of Thessaloniki, Greece
P. Saha, Dept. OB/GYN, Queen Elizabeth II Hospital, Welwyn Garden
City, UK.                                                                     Objectives: In order to investigate whether individuals homozygous for
                                                                              arginine at codon 72 of the p53 gene are more susceptible to human
Objectives: In the United Kingdom two mild dyskaryosis or borderline          papillomavirus(HPV)-related carcinogenesis than heterozygotes, we
smears warrant colposcopy referral. To observe the colposcopy findings        examined the frequency of p53-codon 72 polymorphism in samples from
and colposcopy guided biopsy outcome of mild cytological                      both invasive and intraepithelial cervical neoplasias (CIN), and
abnormalities in tow categories (cat.) 1-Mild dyskaryosis with or             compared them with samples from healthy controls.
without warty atypia, 2-Inflammatory smears without dyskaryosis in a          Study Methods: All 88 samples came from women with a Greek ethnic
set up of ‘Select and Treat’ Policy at St. Albans City Hospital.              background. Tissue specimens were collected from archival material
Study Methods: A retrospective eleven years (1.4.1987-31.3.1998)              with histologically diagnosed low-grade CIN (LGCIN, n=16), high-
analysis of the colposcopic impression and guided biopsy performed by         grade CIN (HGCIN, n=30) or cervical cancer (CxCa, n=12). As a
two colposcopist and single laboratory when the index smear suggesting        control we used cellular material from the cervices of 30 healthy women
low grade disease.                                                            with normal cytological and colposcopical examinations. All specimens
Results: All women of cat.1(587 women) and cat.2(114 women) had               were tested for the presence of HPV 16/18 DNA by PCR-based method
colposcopy and guided biopsy. In cat.1 by colposcopy 304(57.9%)               with MY09 and MY11 primers.
women were suspected to have high grade lesion (cervical intraepithelial      Results: p53Arg homozygosity (Arg/Arg) alone was associated with a 4,
lesion (CIN) II-III), 166(28.3%) CIN-I and 81(13.8%) had normal               6, or 8-fold increased risk for LGCIN, HGCIN or invasive cancer,
appearance. Whereas colposcopic guided biopsy revealed 264(45%) had           respectively. The frequency of the p53Arg/Arg genotype and of the
high grade lesion (CIN II-III) 201 (34.2%) CIN-I and 122(20.8%) were          proline(Pro)-allele showed significant linear trends according to the
normal. In cat.2 colposcopy appearance suggested 54(47.4%) CIN II-III,        degree of severity of the lesion (p=0.0007 and p=0.0009 respectively).
31(27.2%) cin-i AND 29(25.4%) normal but the biopsy confirmed                 Exclusion of the 10 HPV16/18 negative cases did not substantially alter
43(37.7%) CIN II-III, 37(32.4%) CIN-I and 42(29.8%) were normal.              the Arg/Arg frequency among the groups nor the significant linear trend
Conclusions: Although colposcopy is associated with some over                 (Odds ratios for LGCIN, HGCIN and CxCa were 5.33, 4.67 and 6.67
diagnosis but both colposcopy and guided biopsy revealed a high               respectively).In our samples of all groups the distribution of the p53
percentage of high grade lesions in both mild dyskaryosis and                 alleles fits the Hardy-Weinberg equilibrium.
inflammatory group with or without warty atypia thus suggesting all           Conclusion: Our present small study results, speaking in favour of a
abnormal smears need colposcopy referral.                                     biologically relevant association, provide a strong evidence that
                                                                              homozygous arginine in codon 72 of p53 may confer a higher
                                                                              susceptibility to HPV-associated intraepithelial and invasive cervical
FC1.21.04                                                                     neoplasia.
S. Burns, L. Nelson, P. Maguire, G. Dunn, M. Desai, H. Kitchener.             FC1.21.06
Academic unit of Obstetrics and Gynaecology, St. Mary’s Hospital,             ABOUT THE MECHANISMS OF DEVELOPMENT DYSPLASIA
Manchester, UK                                                                CERVIX UTERY
                                                                              E. Rudakova (1), A. Kononov (2)
Objectives: This study aims to determine whether enabling a women to          (1) Dept. OB/GYN, Omsk Medical Academy, Omsk, Russia.
choose between a management policy of cytological surveillance or             (2) Dept. PAT/ANAT, Omsk Medical Academy, Omsk, Russia.
immediate coloposcopy produces a better outcome than cytological
surveillance, in terms of psychological distress, quality of life and         Objectives: The aim of the study was to investigate the mechanisms of
clinical default.                                                             development dysplasia cervix uteri with ectopia and sexually transmitted
Study Methods: Eligible women were randomised following a report of           infections.
mild or a second borderline smear to either the standard arm (cytological     Study Methods: 128 patient-women with ectopia and sexually
surveillance) or the experimental arm (choice between colposcopy or           transmitted infections were examined. We used these study methods:
continued surveillance). This trial involves a Zelen design where women       clinical methods, colposcopia, cytological and histophathological
are randomised prior to consent in order to avoid selection bias in the       methods, historadioautographic and electronical microscopia, for
study population. All women undergo 6 and 12 month review. Those on           diagnostic sexually transmitted infections – bacteriological, cytological
cytological surveillance undergo colposcopy at 6 months if a repeat           and immunological methods.
smear is still abnormal.                                                      Results: Our investigations showed that 93.8% dysplasia cervix utery
Psychometric and quality of life measures are recorded at baseline, at        with ectopia depended on sexually transmitted infections, especially
initial colposcopy if chosen, at 6 month review (pre- and post- result), at   chlamydiasis and viral infections. The colposcopical manifestation of
colposcopy if indicated for persistent abnormality and at 12 months           sexually transmitted infections may be considered hypervascularization
(post-result).                                                                and different atypical colposcopical pictures. The histopathological
The main outcome measures are the General Health Questionnaire and            methods with historadioautography and electronical microscopia showed
the Speilberger Anxiety State and Trait Inventory, and the primary            that sexually-transmitted infections with ectopia stimulated the alteration
outcome is psychological distress.                                            of epithelial cells cervix utery, intensified permeability of epithelial
Results: Recruitment closed in August 1999 with a total of 474 women.         layer and proliferative activity basalis integumental epithelial cells (until
243 were pre-randomised to standard management and 231 to the choice          60 percent and higher such with dysplasia cervix uteri).
arm. Of those given a choice, 131 chose immediate colposcopy and 100          Conclusion: Sexually-transmitted infections are the disturbing factors of
women chose continued surveillance. Analysis of baseline data showed          reparational processes on cervix uteri with ectopia by stimulating of
MONDAY, SEPTEMBER 4                                                                                                                                     55

proliferative activity basalis epithelial cells to the detriment of           FC1.21.09
differentiation, that may lead to the dysplasia. All these results of         RELATIONSHIP OF THE T4/T8 LYMPHOCYTE RATIO TO
investigation make it possible to refer the women with sexually               SMOKING IN PATIENTS WITH PREINVASIVE AND INVASIVE
transmitted infections and ectopia to a group at risk of developing           CERVICAL DISEASE
dysplasia cervix utery and needing active specific treatment.                 V. Kesic, S. Petkovic, T. Bozanovic, Institute of Obstetrics and
                                                                              Gynecology, University Clinical Center, Belgrade, Yugoslavia.

FC1.21.07                                                                     Cigarette smoking has been established as a risk factor for cervical
TELOMERASE AND CERVICAL NEOPLASIA – A                                         neoplasia. There is evidence that smoking may induce diverse changes
LONGITUDINAL STUDY                                                            in the immune system. One index of an impaired immune response is a
U.B. Knudsen (1), M. Herbslet (2), T. Oerntoft (2), P. Bichel (3), B.         reduced ratio of T4/T8 peripheral blood lymphocytes which is
Norrild (4), O. Mogensen (1).                                                 demonstrated in the tissues and peripheral blood of patients with cervical
(1) Dept. OB/GYN, University Hospital, Aarhus, Denmark.                       neoplasia.
(2) Dept. Clinical Biochemistry, University Hospital, Aarhus, Denmark.        Objectives: The aim of the study was to investigate whether a T4/T8
(3) Dept. Pathology, University Hospital, Aarhus, Denmark.                    ratio in peripheral blood of patients with cervical neoplasia is altered in
(4) Dept. Protein Laboratory, Panum Institute, University of                  relation to smoking.
Copenhagen, Denmark.                                                          Study Methods:117 women were included in this study: 35 with CIN, 35
                                                                              with invasive cervical cancer and 42 healthy women who represented
Objectives: The aim of the study was to investigate the activity of           the control group. Peripheral blood lymphocytes were determined by an
telomerase in relation to cervical displaysia and cancer. Furthermore, the    indirect immunoperoxidase technique using OKT4 and OKT8
Human Papilloma Virus (HPV) in the cervical specimens was also                monoclonal antibodies.
measured and related to the telomerase activity and histopathology.           Results: The mean T4/T8 lymphocyte ratio
Study Methods: Two hundred and fourteen women were included and                                        Smokers          Non-smokers
classified at their first visit as CIN I (N=32), CIN II (N=30), CIN III         CIN                    1.61             1.40
(N=84), Cancers (N=24) and controls (N=44). Mean observation period             Cervical cancer        1.25             1.42
for women with CIN I and II changes was 9 months. Activity of                   Control group          1.85             2.27
telomerase was measured by the TRAP-assay. HPV was detected by                Conclusions: The study demonstrated an association between decreased
PCR method.                                                                   T4/T8 lymphocyte ratio and smoking in control group of patients. The
Results: Seventy-eight percent of the women with CIN II at their first        T4/T8 ratio in patients with CIN and cervical cancer is decreased but
visit and a telomerase activity score of 3 or higher progressed in grade of   does not alter significantly in relation to smoking. If discussed in light of
cervical dysplasia over the observation time.                                 previously published studies which confirm a local immunosuppression
A low telomerase activity score at the first visit both for women with        in the cervical epithelium produced by smoking, as well as the
CIN I and II neoplasia indicated a low risk of progression. HPV results       improvement of T4/T8 lymphocyte ratio in the peripheral blood after
will be presented.                                                            treatment of cervix, our results suggest that immunosuppressive effect of
Conclusions: The telomerase activity was significantly positively             smoking can be an independent risk factor for the onset of cervical
correlated to increasing grade of dysplasia. Women with CIN II and a          neoplasia, but that the further persistence of cervical neoplasia may
high score of telomerase activity at the first visit had a high risk of       depend on its ability to suppress the local immune response.
developing CIN III during the observation time. Telomerase activity
may help identify women at risk of progression in grade of dysplasia.
                                                                              FC1.22 CONTRACEPTION 2
FC1.21.08                                                                     FC1.22.01
T. Iwasaka, P.-S. Zheng, M. Yokoyama, H. Sugimori,                            J.K. Jain, Dept. OB/GYN, University of Southern California Keck
Dept OB/GYN, Saga Medical School, Saga, Japan                                 School of Medicine, Los Angeles, California, USA.
Objectives: To evaluate telomerase activity in exfoliated cervical cells      Objectives: A randomized comparative study was undertaken to
and its association with cytology, pathology, and human papillomavirus        compare the effect of ovarian follicular activity associated with use of
(HPV)                                                                         Lunelle, a once-a month injectable contraceptive containing estradiol
Study Methods: Telomerase activity and HPV DNA sequences were                 cypionate 5 mg and medroxyprogesterone acetate 25 mg, and a low-dose
examined in the exfoliated cervical cells from a general population of        oral contraceptive (OC) containing ethinyl estradiol 20 mg and 0.1 mg of
245 women aged more than 30 years undergoing routine cervical                 levonorgestrel.
screening by Papanicolaou smear. The women who were found to have             Study Methods: 30 subjects with regular cycles had pelvic sonography
telomerase activity or abnormal cytology in their exfoliated cervical         performed on cycle days 8, 10, 12, 14 and 16 prior to treatment to
cells were examined for cervical lesions by colposcopy and biopsy.            confirm the presence of gradual development and rapid disappearance of
Results: Cytolgy for our population (mean, 56 years) revealed only one        a dominant follicle, a pattern consistent with ovulation. Subjects were
abnormal smear (1/245, 0.4%), in which a cervical intraepithelial             then randomly assigned to receive 2 cycles of treatment with either an
neoplasia grade I (CIN I) lesion was found. The exfoliated cervical cells     OC or Lunelle. During the second cycle of treatment, pelvic sonography
used to prepare the smear were negative for telomerase and contained          was performed on cycle days 4, 8, 12, 16, 20, 24 and 28 at which time
low-risk HPV DNA. Telomerase activity was found in nine of these              the maximum follicle diameter was measured.
samples (16/245, 6.5%), high-risk HPV DNA was found in nine of these          Results: 13 of 15 subjects in OC groups and 14/15 in the Lunelle group
samples (9/16,56%), and nine of the biopsy specimens that could be            completed the study. Follicles measuring ³ 10 mm were present in 11.13
evaluated form patients testing positive for telomerase revealed CIN I        (84.6%) in the OC users and 4/14 (28.6%) in the Lunelle users
lesions (9/11,82%).                                                           (P=<0.05). In the OC users, 6/13 (46.1%) developed follicles ³ 20 mm
Conclusions: Telomerase activity is often associated with high-risk HPV       and 1.13 (7.7%) developed follicles ³ 30 mm. No subjects in the Lunelle
infection and it is suggested that telomerase assay can help to detect        group developed a follicle ³ 20 mm in diameter.
occult cervical lesions.                                                      Conclusions: This study indicates that Lunelle is associated with a
                                                                              significantly lower incidence of ovarian follicular development
                                                                              compared to use of an OC containing 20 mg of ethinyl estradiol and 0.1
                                                                              mg of levonorgestrel.
56                                                                                                                       MONDAY, SEPTEMBER 4

FC1.22.02                                                                     FC1.22.04
J. M. Cooper (1), J. Kerin (2), B. Van Herendael (3), T. Price (4)            D. Reinprayoon (1), S. Taneepanichskul (1), S. Bunyavejchevin (1), P.
(1) University of Arizona School of Medicine, Tuscon, Arizona, USA.           Thaithumyanon (2), S. Punnahitananda (2), P. Tosukhowong (3),
(2) University of Adelaide, Adelaide, Australia.                              Chulalongkorn University, Bangkok, Thailand.
(3) Jan Palfjin General Hospital, Antwerp, Belgium.                           (1) Dept. OB/GYN (2) Dept. of Pediatrics (3) Dept. of Biochemisty
(4) Greenville Hospital System, Greenville, South Carolina, USA.
                                                                              Objectives: The aim of this project is to study the effects of Implanon
Objectives: A Phase II study is ongoing to evaluate the ability of STOP       implant on the volume and quantity of breast milk compared to an IUD
device to safely and effectively prevent pregnancy in women who are           and to determine in the implant users the concentration of etonogestrel in
seeking permanent contraception. The STOP procedure obviates the              breast milk and compare these to the concentrations in the maternal
need for incisional surgery and general anesthesia.                           serum.
Study Methods: 88 women have been enrolled for transcervical tubal            Study Methods: 80 healthy subjects, aged 18 – 40 years, fully lactating
placement of the STOP device. The STOP device (Conceptus, Inc.) is a          for 4-month period, having BMI 18 – 29, 42 in the Implanon group and
dynamic, micro-coil that is hysteroscopically inserted into the fallopian     38 in the IUD group were enrolled in this open, non-randomized
tube at a reduced diameter and expands upon deployment to the                 comparative study. The 24-hr. volume of breast milk was to be
fallopian tube lemen. The mechanism of action is a combination of the         determined by weighing of infant and breast pump. The composition of
space filling design of the STOP device and a local, benign tissue            breast milk was to be assessed by the determination of total fat, total
response to polyester fibers.                                                 protein and lactose concentrations in the breast milk. Milk analysis was
Results: Bilateral device placement was achieved in 76/88 patients            to be performed prior to the start of treatment and after one, two and four
(86%). Average procedure time was 22 minutes. Patient tolerance of the        month of treatment. Serum etonogestrel concentrations were to be
device placement procedure was rated as good to excellent in 91% of           assessed by means of radioimmunoassay with sample purification using
cases. Patient tolerance to wearing the devices has been rated as very        solid phase extraction.
good to excellent in 100% of cases. HSG performed at the three-month          Results: Determination of 24-hour volume of breast milk for Implanon
follow-up visit demonstrated occlusion in 100% of patients with devices       group vs the IUD group at baseline month 1, month 2, month 4 and last
placed in tubes. Device-related adverse events have been reported in 6%       measurement were 637 ± vs 659 ± 162 ml, 655 ± 154 vs 617 ± 173 ml,
of cases with no clinical sequelae reported to date. There are 302 woman      648 ± 211 vs 600 ± 195 ml, 599 ± 195 vs 667 ± 196 ml and 589 ± 192 vs
months of wearing and 97 woman months of effectiveness with no                560 ± 189 ml, respectively. These differences were not statistically
reports of pregnancies to date.                                               significant. The total protein, total fat and lactose content of breast milk
Conclusions: Preliminary date indicate that the STOP device may be a          were not statistically significant differences. The mean transfer of
safe and effective alternative for permanent contraception. A pivotal trial   etonogestrel (ENG) to the infant for up to 4 months were highest at
is planned to commence in the first half of 2000.                             month 1 and amounted to 19.86 ng/kg/day. Concentration decreased
                                                                              with time.
                                                                              Conclusions: In lactating women, treatment with Implanon or an IUD up
FC1.22.03                                                                     to 4 months did not differ with regard to the effect on the 24-hours
THE EFFECT ON CONTRACEPTIVE USE AND PREGNANCY                                 volume of breast milk and on the composition of breast milk. The mean
RATES (POSTPARTUM) OF GIVING EXPERT CONTRACEPTIVE                             transfer of ENG to infant for up to 4 months was highest at month 1.
COUNSELING IN THE ANTENATAL CLINIC                                            Concentrations decreased with time.
L. Cheng (1), X. Hu (1), Z. Van der Spuy (2), M. Heap (2), A. Mayo (3),
A. Glasier (3)
(1) Shanghai Institute of Family Planning Technical Instruction,              FC1.22.05
    Shanghai, China.                                                          CONTRACEPTIVE POTENTIAL OF ORAL DESOGESTREL WITH
(2) Dept. OB/GYN, University of Cape Town, Cape Town, South                   DEPOT TESTOSTERONE IN MEN
    Africa.                                                                   D. Kinniburgh (1), R.A. Anderson (1), L. Cheng (2), H. Zhu (1), D.T.
(3) University of Edinburgh, Edinburgh, Scotland.                             Baird (1),
                                                                              (1) Contraceptive Development Network, Centre for Reproductive
Objectives: To determine whether expert contraceptive counseling given            Biology, University of Edinburgh, UK.
during the antenatal period affects contraceptive prevalence, patterns of     (2) Institute of Family Planning Technical Instruction, Shanghai, PRC.
contraceptive use and pregnancy rates during one year after childbirth.
Study Methods                                                                 Objectives: To determine the degree of suppression of spermatogenesis
Over 500 women attending antenatal clinics in each of three centers           resulting form daily oral desogestrel with depot prepartain of
(Shanghai, PRC; Edinburgh, Scotland; Cape Town, South Africa) were            testosterone in two populations of men.
randomized either to receive expert contraceptive advice (subjects            Study Methods: Normal men were recruited in Edingburgh (n=30) and
n=771) or the standard advice routinely given in that setting (controls       Shanghai (n=36) and randomized to take either 150mg or 300mg
n=866). Follow-up was by a questionnaire at 16 and 52 weeks after             desogestrel (dsg) p.o. daily for 24 weeks. All men additionally received
childbirth.                                                                   2x200mg testosterone pellets s.c. at start of treatment and 12 weeks
Results: There were no significant differences in the prevalence of           later. In an ‘extension phase’ of the study, men who became
contraceptive use at one year (over 79% in all centers) between subjects      azoospermic during treatment could continue treatment for a further 24
and controls. In Edinburgh, subjects were more likely to undergo              weeks. Such subjects continued oral desogestrel daily at the original
sterilization (p<0.01, t test) than controls, otherwise there were no         dose with further testosterone administration at 12 week intervals. No
differences in Edinburgh, Shanghai or Cape Town in either the methods         other methods of contraception were used during the extension phase.
of contraception chosen or in the methods used over time. Contraceptive       Results: Spermatogenensis was profoundly suppressed in all men. In the
counseling delivered antenatally appeared to have no impact on the            Edinburgh cohort sperm concentration fell from 76.2±12.8 to 0.7±0.7
pregnancy rate during the first year after childbirth. In Shanghai, over      M/ml after 24 weeks in the dsg150 group with 11/13 men (85%)
11% of women in both groups underwent termination of pregnancy in             becoming azoospermic. Pretreatment sperm concentration in the dsg300
the year of follow-up.                                                        group was 60.4±10.4 million/ml: all men became azoospermic (14/14)
Conclusions: Contraceptive counseling during the antenatal period             by 16 weeks treatment. Similar results were obtained in Shanghai:
seems sensible but has very little impact on contraceptive use or             pretreatment sperm concentrations were 75.6±9.9 and 98.9±11.3 M/ml
subsequent pregnancy rates. Unintended pregnancy is common in                 in the 2 groups, and fell to 11.5±5.8 M/m (11/18, 61% azoospermic) in
Shanghai in the first year after childbirth because women use less            the dsg150 group with azoospermia in all men (12/12) in the dsg300
effective contraceptive methods.                                              group. 11 men (6 and 5 in dsg150 and dsg300 groups respectively)
                                                                              completed the extension phase: all remained azoospermic and there were
                                                                              no pregnancies in their partners. Sperm concentrations recovered to re-
                                                                              treatment values in all men on discontinuing dsg. Testosterone levels
                                                                              remained in the normal range in all groups throughout the study.
MONDAY, SEPTEMBER 4                                                                                                                               57

Subjects withdrew from the study for the following reasons; problems        FC1.22.08
with implants (3), raised BP (1), acne (1), mood swings (1), or personal    INCIDENTAL FINDINGS ON LAPAROSCOPIC STERILIZATION
reasons (2).                                                                IN CAMPS
Conclusions: This regimen demonstrates the value of a depot                 P. Chatterjee, T. Ghosh, R. G. Kar, Dept. OB/GYN, Medical College
testosterone preparation in combination with oral desogesterel in           and Hospital, India.
achieving universal azoospermia while avoiding non-physiological
testosterone concentrations. Repeated administration of depot               Objectives: The aim of the study was to explore possibility of many
testosterone with self-administered daily oral desogestrel offers the       obscure gynecological pelvic pathology on mass Voluntary
potential for long-term hormonal contraception for men.                     Laparoscopic Sterilization Operation in rural camps.
This study was supported by DFID/MRC (grant no G9523250).                   Study Methods: 4 300 women were screened during laparoscopic
                                                                            sterilization with falope-ring application. Each team constituted two
                                                                            gynecologists, one anesthetist and five para-medical staff. During 1985
FC1.22.06                                                                   to 1989 ten such teams organized camps at several remote villages of
EFFECT OF TWO LOW-DOSE ORAL ETHINYLESTRADIOL/                               West Bengal. Total number of Voluntary Sterilization by laparoscope
LEVONORGESTREL CONTRACEPTIVES ON PROSTACYCLIN                               was 28 400.
AND THROMBOXANE AS MARKERS FOR VASOACTIVE                                   Results: The following pathological conditions of female genital tract
ACTION                                                                      were diagnosed and treated at the site or transferring the patient to a
A. O. Mueck (1), H. Seeger (1), G. Petersen (2), G. Lorkowski (2), A. T.    hospital. Acute Salpingitis (0.34%). Tubo-ovarian mass (1.2%), Tubal
Teichmann (3), D. Wallwiener (1)                                            Pregnancy (0.27%), Hydrosalpinx (4%) Greyish nodules on tubes and on
(1) Section of Gynecological Endocrinology and Menopause, Dept.             peritoneal surfaces (Koch’s) – (0.3%), simple Serouscystadenoma of
     OB/GYN, University Hospital, Tuebingen, Germany                        ovary (0.2%), Fimbrial cyst (> 8 cm diam. 0.23%), Papillary carc. of
(2) Wyeth-Pharma, Muenster, Germany                                         tube (0.02%), chronic cervicitis (0.41%), Carcinoma of cervix (0.07%),
(3) Women’s Hospital, Aschaffenburg, Germany                                cervical polyp (Mucous) (0.2%), Bartholin’s cyst (0.11%).
                                                                            Conclusions: Laparoscopic Sterilization gained much popularity in rural
Objectives: Until now, few data have been published on the possible         camps of the developing countries – a safe, effective and quick method
direct vascular action of oral contraceptives (OCs). Biochemical            in the 1980s.
vasoactive markers may be useful to explore such affects. The aim was       This procedure can be used simultaneously as a diagnostic tool by all
to assess the urinary excretion of prostacyclin and its counterpart         expert laparoscopist-gynecologists.
thromboxane during treatment with two ethinylestradiol/levonorgestrel       Camp Sterilization may be utilized as a most suitable screening site for
(EE/LNG) OCs.                                                               the womenfolk between 25-35yrs.
Study Methods: Doubleblind, randomized parallel-group study; Leiosâ         Vaginal pools, Cervical Serapings & peritoneal aspirate-cytology in
(0.02 mg EE/0.1 mg LNG; n=34) vs. Stediril 30â (0.03 mg EE/0.15 mg          addition to clinical examinations – many cases of early genital
LNG, n = 33); 8h night urine at baseline, and during the last week of       malignancies can be diagnosed.
cycle 3 and 12. The excretion of metabolites of prostacyclin (DNPGF)        An expert eye through laparoscope can serve “dual” purpose – (1)
and thromboxane (DHTxB) was measured by EIA.                                Control of Population (2) Screening of many obscure female diseases.
Results: For DNPGF no significant changes were found. The excretion
of DHTxB significantly was reduced in both groups after treatment for
12 cycles. The ratio of DNPGF to DHTxB, crucial for the resulting           FC1.22.09
vascular effect, significantly increased in both groups. Between groups,    TETRACYCLINE HCL DOES NOT AFFECT THE
no significant differences were observed.                                   PHARMACOKINETICS OF A CONTRACEPTVIE PATCH
Conclusions: Both Leiosâ and Stediril 30â can shift the balance of          L.S. Abrams1, D. Skee1, J. Natarajan1, W. Hutman2, F. Wong1
prostacyclin to thromboxane towards dominance of the vasodialatory            The R.W. Johnson Pharmaceutical Research Institute, Raritan, New
and antithrombotic compound. This may contribute to reduce the low          Jersey, USA.
risk of thrombosis and arterial diseases found with low dose of OCs.          South Florida Bioavailability Clinic, Miami, Florida, USA.

                                                                            Objectives: It has been suggested that tetracycline HCl decreases gut
FC1.22.07                                                                   absorption of 17-deacetylnorgestimate (17d-NGM) and ethinyl estradiol
WHICH FACTORS INFLUENCED THE USE AND CHOICE OF                              (EE) when orally administered. The objective of this study was to
CONTRACEPTIVES AMONG TEENAGERS UNDERGOING                                   evaluate the pharmacokinetics of 17d-NGM and EE following
INDUCED ABORTION?                                                           application of a contraceptive patch (EVRAÔ), with or without
G. Bártfa, Z. Kozinszky, Dept. OB/GYN, University of Szeged, Faculty        coadministration of tetracycline HCl.
of General Medicine, Szeged, Hungary.                                       Study Methods: In this randomized, open-label, crossover study, 24
                                                                            healthy women wore a 20 cm2 patch (designed to deliver to the systemic
Objectives: A better knowledge of contraception determinants may lead       circulation 150 mg/d 17d-NGM and 20 mg/d EE) for 1 week (168 hours),
to a decrease in the number of abortions in this subpopulation.             followed by a 1-month washout period, then 1 week with EVRAÔ and
Study Methods: An anonymous questionnaire survey among teenagers.           coadministered tetracycline HCl 500 mg orally every 6 hours, or the
Data analysis: chi-square and McNemar tests.                                patch for 1 week with coadministered tetracycline HCl 500 mg, followed
Results: Under-age girls used a condom or relied on luck. From 18 years     by a 1-month washout period, then 1 week with only EVRAÔ. When
onwards, the contraceptive pill became increasingly popular. However,       tetracycline was administered, it was taken 3 days prior to patch
about half of these latter girls (43%) considered this reliable             application and continued until the patch was removed. Serum samples
contraceptive methods unaffordable, and the vast majority (96%) were        were analyzed for 17d-NGM (analyzed by high pressure liquid
ill-informed concerning the basic characteristics of the menstrual cycle.   chromatography/mass spectrometry), and EE (analyzed by gas
The main source of information was the written media 37%, followed by       chromatography/mass spectrometry) from samples collected at 0, 6, 12,
the partner (35%) and family (25%). The role of health-care providers       24, 48, 72, 120, 144, 168, 171, 174, 180, 192, 204, 216, and 240 hours
was negligible (16%), except among oral contraceptive users (P<0.001).      after each patch application (each patch removed after 168 hours). The
Following the abortion experience, 95% of the surveyed teenagers            pharmacokinetic parameters calculated were: Tmax, Cmax, Css, Cavg,
would prefer a reliable method in the future.                               AUC0-168, AUC0-240, AUC0-µ, and t1/2. Safety evaluations were based on
Conclusions: To be well informed about contraception is of paramount        changes in physical and gynecologic examinations, vital signs, clinical
importance. The roles of the media and particularly the family members      laboratory tests, and reported adverse events.
are emphasized.                                                             Results: There were no statistically significant differences in any
                                                                            calculated pharmacokinetic parameters of 17d-NGM or EE, in subjects
                                                                            using EVRAÔ alone, or with tetracycline HCl treatment. There were no
                                                                            serious adverse events or discontinuations due to adverse events and no
                                                                            clinically significant changes in any of the safety evaluations. No patch
                                                                            became detached.
58                                                                                                                     MONDAY, SEPTEMBER 4

Conclusions: Coadministration of tetracycline HCl with the                   FC1.23.03
contraceptive patch did not affect the pharmacokinetics of 17d-NGM or        DEVELOPMENT-DEPENDENT GLUCOCORTICOID
EE. Based on these data, tetracycline is not expected to affect the          METABOLISM IN HUMAN OVARIAN GRANULOSA CELLS
contraceptive efficacy of EVRAÔ. Treatment with EVRAÔ, with or               P.Y.K.Yong, J.Thong, *R.Andrew, *B.Walker, S.G.Hillier; University
without tetracycline HCl, was safe and well tolerated.                       of Edinburgh, Centre For Reproductive Biology, 37 Chalmers Street,
                                                                             Edinburgh EH3 9EW; *Molecular Medicine Centre, Crewe Road,
                                                                             Edinburgh EH4 2XU, United Kingdom
                                                                             Objectives: 11b hydroxysteroid dehydrogenase (11bHSD), which is
FC1.23.01                                                                    responsible for the bidirectional conversion between cortisol (F) and its
EXPOSURE OF PRIMARY HUMAN TROPHOBLAST CELLS TO                               inactive form, cortisone (E), has been implicated in the regulation of
CYTOKINES INDUCES SURFACE AND SOLUBLE CHEMOKINE                              ovarian folliculogenesis and oogenesis. Expression of its two known
RECEPTORS (CCRs)                                                             isomers (11bHSD1, 11bHSD2) by human granulosa cells (GC) has been
S. Vassiliadis (1), E. Koumantakis (2), I. Athanassakis (1).                 shown to be developmentally regulated. Immature GC (IGC) almost
(1) Dept. Biology, University of Crete, Heraklion, Greece.                   exclusively express 11bHSD2 mRNA while luteinised GC (LGC)
(2) Dept. OB/GYN, University Hospital, Heraklion, Greece.                    express predominantly 11bHSD1 mRNA. The aims of this study were:
                                                                             (1) to confirm the switch in 11bHSD expression from type 2 to type 1 by
Objectives: We examined the ability of IFN-g and IL-4 to induce CCR3         measuring the interconversion between E and F in IGC and LGC, and
or CXCR4 on mature human trophoblast cells from term placenta since          follicular fluid levels of E and F, and (2) to determine if 11bHSD1
expression of CCRs on trophoblast cells may provide a valid mechanism        reductase activity (E to F conversion) is gonadotrophically regulated in
for the in utero transmission of HIV.                                        vitro.
Study Methods: We defined the constitutive and inducible expression of       Methods: LGC were aspirated from periovulatory follicles in IVF
surface CCR3 and CXCR4 on primary human trophoblasts during short            patients during oocyte recovery, 35h after injection of hCG. IGC were
periods of cell culture by immunofluorescence after exposure to IFN-g        collected from antral follicles (3-16mm) in women undergoing          4
and IL-4. In addition, released CCR activity was also monitored by           oophorectomy for benign gynaecological conditions. Cells (1-5 x 10 )
ELISA.                                                                       were incubated for 4h at 37°C in medium 199 containing 50pmol of E
Results: Kinetic experiments show that the constitutive expression of        and F, which included 0.1mCi [ H]-E or F, followed by steroid
both CCR3 and CXCR4 reach a peak of expression after 6 hours of              extraction, thin-layer chromatography, and spectrometry to determine %
culture, whereas by 24 hours they have almost disappeared. In the            conversion between E and F. For objective (2), IGC was incubated with
presence of IFN-g, CCR3 increases in expression after 4 hours of             FSH and LH for 48h before the 4h incubation described above.
incubation, reaching highest levels at 24 hours of culture, whereas          Experiments in triplicate.
CXCR4 is kept at lower levels as compared to non-treated cells. In the       Results: Results are mean±SEM values. % conversion of E to F by LGC
presence of IL-4, CCR3 declines from 2 to 8 hours of culture to increase     (n=7) was 36.3±3.7%, compared with only 0.6±0.4% for IGC (n=5)
again at 24 hours by 50%. Under the IL-4 stimulus, CXCR4 shows a             (p<0.01). Conversion of F to E was similar for both groups:
peak of expression at 8 hours of culture. Interestingly, we detect soluble   31.0±2.9% for LGC and 41.7±7.4% for IGC. In IGC cultures (n=3),
CCR activity in the culture supernatants of trophoblast cells, which         FSH (10ng/ml) increased conversion of E to F by a factor of 57.8±19.9
follows an inversely proportional pattern of that corresponding to           times over control incubations, without added gonadotrophins, while the
surface expression.                                                          corresponding value for LH (10ng/ml) was 3.59±2.11. The FSH effect
Conclusions: Surface induced expression of CCRs on trophoblast cells         was dose-dependent. The ratio of follicular fluid levels of F : E was
has a fast turnover rate between 2 and 8 hours of culture. The released      almost 3 times greater in periovulatory than immature follicles (p<0.01).
CCR activity, however, may account for the development of an                 Conclusion: These data provide experimental confirmation of a switch in
inhibitory mechanism against viral transmission by absorbing virions in      11bHSD expression from type 2 in immature follicles to type 1 in
the extracellular matrix.                                                    periovulatory follicles. We have shown for the first time that 11bHSD1
                                                                             reductase activity is upregulated in vitro by FSH and to a much lesser
                                                                             extent LH. The significance of increased follicular cortisol formation
FC1.23.02                                                                    around the time of ovulation remains unclear, but is consistent with an
RECURRENT VENOUS THROMBOEMBOLISM DURING                                      anti-inflammatory role at follicular rupture to mediate repair and healing
HORMONE REPLACEMENT THERAPY. RESULTS OF THE                                  afterwards.
E. Qvigtad, E. Hoibraaten, H. Arnesen, S. Larsen, E. Wickstrom, PM
Sandset, Ullevaal University Hospital, dept of Hematology, Oslo,             FC1.23.04
Norway.                                                                      DIFFERENTIALLY EXPRESSED GENES IN NORMAL HUMAN
                                                                             MAMMARY TISSUE DURING TAMOXIFEN THERAPY (LUD
Objectives: The aim of the study was to determine if hormone                 5646).
replacement therapy (HRT) alters the risk of venous thromboembolism          I. Silva, L. Gebrim, Federal University São Paulo Brazil, Rua Pedro de
(VTE) in high risk women; i.e. women with previous VTE.                      Toledo 781, 4 th floor, São Paulo, Brazil, 04039032.
Study Methods: Randomized, double-blinded, and placebo-controlled
clinical trial with a stratified design combined with a double-triangular    Introduction: Tamoxifen (TAM) an orally effective, synthetic
sequential design. 140 females with previously verified VTE, were            antiestrogen used first in women with metastatic breast cancer disease
randomized to either 2 mg estradiol plus 1mg norethisteron acetate one       has become an essential part of any therapeutic strategy for the control
tablet daily (n=71) , or placebo (n=60). The primary outcome was the         and prevention of breast cancer. In order to identify TAM responsive
occurrence of deep venous thrombosis or pulmonary embolism.                  genes we performed cDNA arrays using total RNA isolated from normal
Results: 8 women in the hormone group and one woman in the placebo           breast tissue from patients treated with placebo or TAM (20 mg/day) for
group experienced VTE. The study was terminated early based on the           4 weeks. The cDNA fragments used on membranes were generated by
results of circumstantial evidence emerging during the trial. The final      the Human Cancer Genome Project, funded by the Ludwig Institute for
analysis gave a median unbiased estimate of the incidence of VTE of          Cancer Research and FAPESP (Fundação de Amparo à Pesquisa do
2.2% and 10.6% in the placebo group and HRT group respectively               Estado de São Paulo, BRAZIL). This is a program for human gene
(p=0.04). In the hormone group, four women experienced deep venous           discovery and human coding region compilation based on a novel
thrombosis, three pulmonary embolism and one cerebral sinus vein             concept for the high throughput sequencing of human open reading
thrombosis. All these events happened within 220 days after inclusion.       frames. The project consists entirely on the sequencing and analysis of
The one patient in the placebo group suffered pulmonary embolism at          short cDNA fragments generated preferentially from the central coding
day 413.                                                                     portions of expressed human genes obtained from tumors including
Conclusions: In women with previous VTE, HRT increases the risk of           breast, ovarian and cervical cancer. The fragments are termed ORESTES
recurrent VTE and should be avoided. This study confirms the result of       (Open Reading frame ESTs) and are generated using a strategy
the epidemiological studies showing a small increased risk of VTE on         developed and patented by the Ludwig Institute. Within the project it is
HRT, which might be generalized to most women                                aimed to assemble the data, together with existing data in GenBank and
MONDAY, SEPTEMBER 4                                                                                                                                   59

Unigene, into annotated potential complete open reading frames               clinics have sprung up in some states for the determination of sex and
(pORFs). Objectives: To isolate up or down regulated genes induced by        termination of pregnancy, if possible, immediately. Abortion was illegal
short term TAM therapy.                                                      in India, but in 1971, with an eye to population control, the government
Patients and Methods: Human breast normal tissue were obtained at the        introduced the Medical Termination of Pregnancy Act that made
Mastology Group, Gynecology Department at the Federal University of          abortion legal if recommended by a physician and it was found that the
São Paulo Brazil. This randomized, double-blind study included 20            number of abortions soared in the seventies. When the equipment for sex
women with fibroadenoma, half of them (10 women) received 20 mg of           determination tests became available in the eighties, the termination of
TAM/day during 30 days and the other half received placebo for the           female fetuses increased alarmingly. The heinous practice finally
same time. During lumpectomy, with local anesthesia, a fragment of           compelled the government to introduce a specific act. The Prenatal
adjacent normal breast tissue were collected and immediately frozen in       Diagnosis Techniques (Regulation and Prevention of Misuse) Act, 1994,
liquid nitrogen. Total RNA were isolated from tissues using Trizol (Life     made both USG detection of sex and communication of the sex of the
Technologies) and then used as template for reverse transcriptase            fetus in any manner to the mother and family a punishable offence.
reaction (Superscript II, Life Technologies) in the presence of [32P]        However, no case has been registered yet because the family is always in
dCTP. Membranes containing 96 different cDNA fragments were                  league with the physicians. Failing to contain the menace through legal
assembled using clones generated by the Human Cancer Genome Project          instruments, professional bodies that would generally stand by the
(FAPESP-Ludwig Institute for Cancer Research) in São Paulo, Brazil           physicians are being mobilized. Indian Medical Association, the largest
and hybridized overnight to the probes prepared before.                      body of the physicians in the country has come forward to make India
Results: Three differentially expressed genes were found down-               free from female feticide. The members have taken a pledge that they
regulated during TAM treatment in the pool of RNA from TAM treated           will not indulge themselves or be a party to the crime. IMA jointly with
women. The isolated and down-regulated genes were Insulin-like               UNICEF has worked out an action plan, including a countrywide study
Growth Factor Binding Protein 3, Calmodulin-dependent Protein Kinase         on the social, legal and medical issues. The authors, leading state level
II and Tissue Inhibitor of Metalloprotease 3. These results suggests that    leaders in the movement, report on the developments in recent years on
TAM might exerts its actions, on normal human breast tissue, through         the legal and professional side in stopping the unethical practice of
mechanisms that include Insulin-like Growth Factors and invasion             female feticide.
enzymes. In addition, the results suggest that there might be diverse
effects of hormones and neurotransmitters that utilize Ca2+ as a second
messenger.                                                                   FC1.23.07
                                                                             OVARIAN CANCER FOLLOWING INFERTILITY AND FERTILITY
                                                                             DRUG USE. A DANISH COHORT STUDY OF MORE THAN 54,000
FC1.23.05                                                                    INFERTILE WOMEN
GENE TRANSFER TO PLACENTA                                                    S. Krüger Kjaer 1, H. Sharif 1, J. Bock 2, J. H. Olsen 1
Mikko O. Hiltunen1, Annaleena Heikkilä 1,2 Mikko P. Turunen1, Seppo          1
                                                                               Institute of Cancer Epidemiology, Danish Cancer Society,
Heinonen2, Mari Niemi1, Heikki Räsänen3, Tuomas Rissanen1, Veli-             Copenhagen, Denmark 2 Dept. OB/GYN, Rigshospitalet, Copenhagen,
Matti Kosma-, Anna-Mari Turunen1, Leea Keski-Nisula2, Fuju Chang4            Denmark
and Seppo Ylä-Herttuala1,6,7
  A.I. Virtanen Institute, 2Department of Gynecology and Obstetrics,         Objectives: The overall aim of the study was to examine the cancer
  Department of Radiology, 4Department of Pathology, 5Department of          occurrence in infertile women. The specific aims of this presentation are:
Pathology and Forensic Medicine, 6Department of Medicine and 7Gene           1) to compare the ovarian cancer incidence in a cohort of infertile
Therapy Unit, University of Kuopio, Kuopio, Finland                          women with that of the general population, 2) to elucidate whether
                                                                             infertile women treated with fertility drugs are at a higher risk of ovarian
Objective: If gene therapy could correct placental functional deficiencies   cancer/borderline tumour than infertile women who never received these
in pre-eclampsia, both maternal and fetal morbidity from the disease         medications.
could be markedly reduced. This study was undertaken to investigate          Study methods: We have established a cohort of women evaluated for
whether adenovirus mediated gene transfer is feasible to placenta in a       infertility problems at hospitals and private fertility clinics in Denmark
rabbit model.                                                                1960-1997. Relevant patients were identified from medical files,
Study methods: Ten New Zealand White rabbits were anesthetized on            microfilms, and local computerised registration systems. Further, we
day 21 of gestation. Adenovirus vector carrying the beta-galactosidase       identified patients from the Danish National Registry of Patients,
gene run by CMV promoter was injected via a catheter to both uterine         containing more than 99% of disharges since 1977. The cohort was
arteries under angiographic control. The animals were sacrificed on day      linked to the Medical Birth Register to obtain information on e.g.
24 of gestation and detection of vector was carried out by PCR and X-        lifetime number of pregnancies.
gal histochemistry.                                                          Cancer occurrence was ascertained by linking the cohort to the Danish
Results: Intravascular gene transfer produced high expression of             Cancer Registry, comprising almost all cancers diagnosed in Denmark
enzyme-encoding trangene in placenta demonstrated by beta-                   since 1943. From hospital/clinic files of all the identified cancer cases
galactosidase activity in the nuclei of placental cells and by PCR on        and from a random sample (n~1300) of the cohort, we abstracted
extracts of the trophoblastic tissue. X-gal histochemistry revealed no       detailed information on infertility treatment.
leak to the fetal compartment and structurally normal fetuses were viable    Results: In all, 54,379 women with an infertility diagnosis were included
at the time of termination. Accordingly, gross light-microscopic             in the study. A total of 1086 women developed cancer during follow-up,
histology of the fetoplacental entity was entirely normal.                   including 76 ovarian cancers and 42 ovarian borderline tumours.
Conclusion: Gene transfer produces high-level transgene expression in        Conclusion: We have established one of the largest cohorts of infertile
placenta without marked leakage to fetal tissues and may become a new        women. Due to the existence of nation-wide registers in Denmark and to
method to treat placental disorders.                                         the fact that all Danish inhabitants have a unique personal ID-number, it
                                                                             is possible to do follow-up studies in Denmark with a nearly complete
                                                                             follow-up. Age-standardized incidence ratios (SIR) as well as results
FC1.23.06                                                                    from the on-going case-cohort analyses regarding the role of fertility
FIGHTING FEMALE FOETICIDE IN INDIA: LEGALLY AND ALSO                         drug use will be presented.
A. Basu-Sengupta (1), K. Banik (2)
(1) Bengal Obstetrics and Gynecology Society, Calcutta, India.               FC1.23.08
(2) Indian Medical Association, Calcutta, India.                             PERMEABILITY OF FETAL MEMBRANES TO CATIONS IN
                                                                             PRETERM LABOR.
The Constitution of India guarantees the fundamental rights of its           T.Laudanski (1), A.Lemancewicz (1), H.Laudanska (1), S.Batra (2), (1)
citizens including non-discrimination on the basis of gender. That           Medical University of Bialystok, M. Curie Sklodowskiej 24a, Bialystok,
violation is taking place through abortion of female fetuses in very large   Poland, 15276, (2) University of Lund, Lund, Sweden.
numbers, which is evident from the declining female male ratio in this
country. This is simply due to gender bias as boys are preferred to girls.   Objective: It is recognized that fetal membranes may play a central role
But this preference is taking a very sinister form. Thousands of medical     in paracrine signaling during the initiation of parturition. Since no
60                                                                                                                    MONDAY, SEPTEMBER 4

previous data are available on diffusion of calcium (Ca) and magnesium     FC1.24.02
(Mg) through fetal membranes, in present study we have examined the        LIPID PROFILE IN WOMEN WITH POLYCYSTIC OVARY
permeability to these cations of chorioamniotic membranes obtained         SYNDROME AND NORMAL BMI
from women at term or preterm labor.                                       D. Panidis1, A. Kourtis2, D. Rousso1, K. Makedou3, V. Panoussis1, G.
Study Methods: Ca and Mg permeability was evaluated using a modified       Vlassis2. Third1 and Fourth2 Dept. OB/GYN, Aristotelian University;
dual chamber method previously described by Lee (1994). Analysis of        Biochem. Lab3. of 2nd Pediatric Clinic of AHEPA Hospital,
cations in the samples was done with ion chromatography using              Thessaloniki, Greece.
METROHM IC-690 chromatograph. The double compartment model
(Godfrey, 1983) was modified to accommodate sample extractions             Objectives: It is generally accepted that the metabolic syndrome is in an
Results: The diffusion of Ca across fetal membrane from term labor was     integral part of the polycystic ovary syndrome (PCOS). This study was
markedly higher than in preterm labor. Perfusion rates for Ca and Mg       designed in order to estimate the levels of total cholesterol, HDL- and
were also higher in term than preterm and the differences were             LDL-cholesterol, triglycerides and Lp(_), in women with PCOS and in
statistically significant.                                                 controls.
Conclusions: The data of the present study showing reduced                 Study methods: Sixty-three selected women, whose age ranged from 14
permeability of Ca and Mg of fetal membranes from preterm labor            to 36 years, were included in this study. Women were divided into two
suggest that this abnormality could be an important factor for the         groups according to the presence of PCOS. The first group comprised 37
activation of myometrium in preterm labor.                                 women with PCOS, aged 14-36 years (mean ±SD, 23.6±5.2 years), with
                                                                           normal BMI, which ranged from 19.1 to 24.8 (21.8±1.7). The second
                                                                           group consisted of 26 women with normal ovulatory cycles, aged 18-34
FC1.23.09                                                                  years (22.5±3.1 years), with normal BMI, which ranged from 17.9 to
EVIDENCE-BASED HEALTHCARE, VALUE OF CRITICAL                               24.8 (20.8±1.9). Blood samples were collected on the sixth day of
APPRAISAL WORKSHOPS                                                        spontaneous or induced menstrual cycle.
L.S. Dwarakanath(1), K.S. Khan(2), A.O. Awonuga(2),                        Results: It was found that: (a) total cholesterol, LDL-cholesterol,
(1) Dept OB/GYN, City Hospital NHS Trust, Birmingham, UK.                  triglycerides and Lp(_) values did not show any significant differences
(2) Academic Dept of OB/GYN, University of Birmingham, UK                  between women with PCOS and controls, (b) HDL-cholesterol levels
                                                                           were significantly lower in women with PCOS than those in controls,
Objectives: To evaluate the effect of literature appraisal workshops on    and (c) there was no significant correlation between HDL values and
participants’ views, attitudes and knowledge about evidence-based          androgen concentrations in women with PCOS.
medicine.                                                                  Conclusions: Our results support the view that women with PCOS have
Study Methods: A program of workshop to promote evidence-based             an increased risk of developing cardiovascular disease, and therefore
obstetrics and gynecology in the West-Midlands, UK.                        they need long-term monitoring and medical treatment.
In 1998, 55 practitioners attended three workshops with the aim to
increase confidence in critical appraisal of the medical literature. The
participants’ performance was evaluated comparing their views,             FC1.24.03
attitudes and knowledge before and after attending the workshops.          PLASMA LEPTIN LEVELS ARE INCREASED IN WOMEN WITH
Results: After attending the workshop, participants paid more attention    PREMENSTRUAL SYNDROME
to the study design (81% vs. 98%, p=0.02), they did not find research      C.Domoney, N.Anim-Nyame, N.Panay, J.Studd, Imperial College of
evidence confusing (35% vs. 59%, p=0.0001). Their mean knowledge           Science, Technology and Medicine, 369 Fulham Road, London, United
scores improved from 47.3 (SD12.2) to 57.9 (SD9.0) (p=0.0001).             Kingdom, SW10 9NH.
Conclusions: Our critical appraisal skills workshop improved attitudes
and knowledge needed for provision of evidence-supported healthcare.       Objective: To investigate the hypothesis that changes in leptin levels
Such workshops should be incorporated in postgraduate obstetric and        during the follicular and luteal phases of the menstrual cycle are
gynecology training programs.                                              different in women with premenstrual syndrome (PMS) as compared to
                                                                           those in asymptomatic cycles. This may contribute to the symptoms of
                                                                           this disease.
FC1.24 DISORDERS OF OVULATION                                              Methods: We measured fasting plasma leptin levels by
                                                                           radioimmunoassay in 21 women with PMS and 22 controls with
FC1.24.01                                                                  asymptomatic menstrual cycles, matched for age, body mass index and
ROLE OF EICOSANOIDS IN MOUSE OVULATION                                     cycle length. Fasting venous blood was drawn during the early follicular
Jiamin Teng, Meijin Tochigi, Chiaki Takeya, Yuki Tanaka, Miki              and midluteal phases.
Mizutani, Noriko Yamamoto, Hiroki Yosinaga, Buichi Tochigi *, Kazuo        Results: Leptin levels increased significantly during the luteal phases of
Satoh Dept. OB/GYN, Nihon University School of Medicine, Tokyo, *          the control and PMS groups compared to the follicular phases. A greater
Dept. OB/GYN, Kawaguchi Medical Center, Saitama, Japan                     increase was observed in women with PMS than the controls (p =
                                                                           0.0002, and 0.007 respectively). Although leptin levels in the follicular
Objectives: In order to investigate the role of eicosanoids in mouse       and luteal phases were higher in women with PMS than the controls, the
ovulation, COXI or II and lipoxygenase (LOX) inhibitor were given to       difference was only statistically significant between the follicular phases
PMSG-hCG injected mice. Ovulation, ovarian PGE2 and oocyte                 (p = 0.02, and 0.41 for follicular and luteal phases respectively). The
morphological changes were observed.                                       increases in leptin in both groups were independent of plasma oestradiol
Study Methods: After PMSG-hCG injection, (hours; +h), Indomethacin         and progesterone levels.
(INDO, 15 mg/kg) or NS-398 (NS, 600 mg/kg) as COXII inhibitor was          Conclusions: These findings suggest that leptin may play a role in the
given at +6h, NDGA (70 mg/kg) as LOX inhibitor +1.5h, PGE2 (3.3-10         pathophysiology of premenstrual syndrome and requires further
mg/kg) +9h after injection of inhibitors. Ovulation and morphology were    evaluation.
observed at every 2 hours. PGE2, PGEm were analyzed at every 3 hours.
Results: No. of ova was 26.2% of that of control in INDO group, 41.4%
in NS-398 and 26.0% in NDGA, which were reversed by PGE2. At               FC1.24.04
+11h, surface epithelium remained intact in inhibitor group. Apical wall   NEUROTRANSMITTERS IN THE REGULATION OF ESTRADIOL
formation in control was 81.1%, INDO 15.4%, NS 36.2%, DNGA 4.7%.           AND PROGESTERONE SECRETION OF HUMAN GRANULOSA
INDO or NDGA significantly inhibited GVBD. INDO inhibited the              CELLS
cumulus expansion. INDO or NS-398 also inhibited Dual peak of              J. Bódis, A.Török, T. Hartmann, H-R Tinneberg*.Dept. OB/GYN
ovarian PGE2.                                                              County Teaching Hospital of Pécs, Hungary, Women´Hospital of
Conclusions: INDO, NS-398 and NDGA inhibited ovulation by different        Bielefeld, Germany*
injected time, PGE2 reversed the inhibition with delayed ovulation in
NDGA that eicosanoids play an important role in but COX and LOX            Objectives : There are experimental data supporting the presence and
take different effects on the ovulation processes.                         actions of various neurotransmitters in the ovary, although their exact
                                                                           function in the regulation of ovarian hormone secretion is unclear. The
                                                                           innervation of the ovary by adrenergic and cholinergic nerves has been
MONDAY, SEPTEMBER 4                                                                                                                                     61

well documented. The objective of the present study was to investigate         FC1.24.06
the direct action of serotonin (5-HT), catecholamines, acetylcholin (AC)       LAPAROSCOPICAL OVARIAN DRILLING IN POLYCISTIC
and histamine (H) on progesterone (P4) and estradiol (E2) secretion of         OVARIAN SYNDROME (PCOS) RESISTANT TO CLOMIFEN
human granulosa cells (GCs) cultured in serum-free condition.                  TREATMENT
Study Methods                                                                  G-E.Juan (1), A.Antonio (2), R.Alberto (1), G.Juan (2), (1) Hospital
Human GCs were isolated from preovulatory follicular fluid using a             Maternal La Fe, Av. Campanar 21, Valencia, Spain, 46009, (2) Hospital
Percoll gradient centrifugation method. Using Linbro Plate multiwell           Arnau de Vilanova, Valencia, Spain.
tissue dishes, 2 cm in diameter, 2 x 105 GCs were cultured per well in
McCoy 5A medium. Treatment of with various neurotransmitters were              Objectives : Study the hormonal and clinical response after ovarian
carried out betwen the 3rd and 4th day of culture. Supernatants from           multipunction procedure (ovarian drilling) with CO2 Laser in patients
cultures were collected after 96 h and stored at -20 °C until assayed. P4      with PCOS. Investigate the evolution on fertility in these patients.
was measured in the culture media samples using the COATRIA 125I-P,            Study Methods : At least 20 ovarian cortical punctions with CO2
the E2 concentrations were measured by a direct RIA kit from Baxter            laser(50 W;spot<0.2mm) were performed in fourteen patients with
Merz + Dade AG. Analysis of variance was used to determine statistical         chronic anovulation resistant to clomifen therapy(100 mg/day) from 5th
significance between the control and treatment groups.                         to 10th day during 3 to 5 cycles.
Results : Serotonin exhibited a significant stimulatory effect on P4           Results : We observed an improvement in ovulatory cycles (0% pre-
secretion by human GCs. The observed effect was dose-related and               treatment vs 50% after treatment), identified by determinations of
inhibited by the specific serotonin antagonist mianserin. The E2               progesterone levels during lutheal phase. The FSH/LH ratio decreases
secretion was also stimulated but without dose-dependency. We                  from 2.8 +/- 0.2 to 1.9 +/-0.15 (p<0.05) 2 months after drilling although
observed an inhibitory effect of noradrenaline on P4 secretion by GCs,         this relation increases to 2.4 +/-0.18 one year after. The pregnancy rate 2
however dopamine significantly stimulated E2 secretion. Both effect            years after treatment was 57%.
could be inhibited by propranolol. Acetylcholine significantly stimulated      Conclusions : Laparoscopical ovarian drilling with CO2 laser is a good
P4 secretion by GCs in a dose-related manner. Estradiol secretion              alternative treatment in patients with PCOS resistant to clomifen
secretion was also stimulated by AC, but this effetc did not shows dose        therapy.
dependency. Atropine could be blocked the stimulatory effect of AC.
We observed a dose-related stimulatory effect of H in E2 by GCs. This
response was specifically blocked by the H1-receptor antagonist                FC1.24.07
terfenadine. P4 production in response to H stimulation was independent        CLINICAL AND LABORATORIAL ASPECTS OF POLICISTIC
of dose at a limit of significance.                                            OVARIAN SYNDROME PATIENTS WITH RESISTANCE INSULIN
Conclusions : The observed effects of neurotransmitters may have a             GAR Maciel, EC Baracat, JM Soares Jr, CE Lang, MG Nunes, MA
phisiological role in the regulation of granulosa cell function during the     Haidar, G Rodrigues de Lima.
menstrual cycle.                                                               Department of Gynecology-Federal University of Sao Paulo, Escola
                                                                               Paulista de Medicina, Sao Paulo, Brazil.

FC1.24.05                                                                      Objective: The aim of this work was to analyze the clinical and
EFFECTS OF CLOMIPHENE CITRATE ON INSULIN-LIKE                                  laboratorial aspects of policistic ovarian syndrome (PCOS) of patients
GROWTH FACTOR BINDING PROTEIN I, INSULIN-LIKE                                  with insulin resistance(IR).
GROWTH FACTOR I AND INSULIN RESISTANCE IN                                      Study Methods: Sixty patients were divided into three groups: GI -
POLYCYSTIC OVARY SYNDROME.                                                     control (n = 20, normal menstrual cycles); GII-PCOS patients without IR
A. la Marca, G. Morgante, D. Lanzetta, M. Torricelli, A. Cianci, V. De         (n=15);GIII-PCOS patients with IR (n=25). We reported clinical
Leo, Department Obstetrics and Gynecology, University of Study of              information such as age and mass body index (MBI), and collected
Siena and Catania, Italy                                                       blood samples to dose total and fraction cholesterol.
                                                                               Results:: The average of age in each group was : GI-25.2 ± 6.2; GII-21.2
Objectives : The induction of ovulation by clomiphene could be the             ± 5.5; GIII-22.0 ± 4.7 and of MBI was :GI-22.9 ± 4.3; GII-22.8 ± 4.1;
result of interaction of the drug at various levels: hypothalamus, pituitary   GIII-28.2 ± 5.4 (p=0.003).
and ovary. It was recently demonstrated that administration of                 The laboratorial data were total cholesterol: GI-156.3 ± 21.7; GII-176.8
clomiphene to women with PCOS is accompanied by a reduction in                 ±18.6; GIII-170.6 ± 35.7 (p= 0.03);
plasma levels of insulin-like growth factor I (IGF-I). IGF-I seems to          HDL: GI-47.5 ± 9.9; GII-46.5 ± 11.2; GIII-36.8 ± 8.0;
have an overall negative effect on normal folliculogenesis and ovulation.      LDL: GI=88.2 ± 25.3; GII-109.7 ± 14.9; GIII-109.4 ± 40.4 (GII @ GIII >
The aim of the present study was to evaluate the effect of clomiphene on       GI, p=0.02);
plasma levels of IGF-I and IGFBP-I and on insulin-resistance associated        VLDL: GI=15.5 ± 7.2; GII = 20.6 ± 7.9; GIII=24.5 ± 16.4;
with PCOS.                                                                     Triglycerides; GI= 82.8 ± 40.2; GII= 102.4 ± 40.4; GIII = 98.2 ± 36.8.
Study Methods : Fifteen patients diagnosed with PCOS were recruited.           Conclusion: The PCOS subjects with IR have greater BMI than other.
Clinical diagnosis was based on chronic oligomenorrhea or amenorrhea           They have lower levels of total cholesterol when compared with PCOS
and hyperandrogenemia. Clomiphene citrate was administered at a dose           patients without IR, but greater than normal women. HDL-C is greater in
of 100 mg/day to all women from day 5 to day 9 of the spontaneous or           PCOS patients with IR have worst lipid profile and may have a
MAP-induced menstrual cycle. Blood sampling and a 2-hour oral                  increased cardiovascular risk.
glucose loading test (75 g) were performed the day before and after the
course of clomiphene.
Results : Ovulation was confirmed in 13/15 PCOS patients. Plasma               FC1.24.08
levels of IGF-I decreased by 31.5% (434± 84 vs 297± 71 ng/ml; p<0.05)          ENDOCRINOLOGIC EFFECTS OF FINASTERIDE IN WOMEN
after 5 days of clomiphene therapy, whereas plasma levels of IGFBP-I           WITH POLYCYSTIC OVARY SYNDROME (PCOS)
increased by about 28.1% (26.3±4 vs 36.6±7 ng/ml; p<0.05). This gave           Arie, WMY; Ueno, J; Bagnoli, Vr; Arie, Mha; Fonseca, Am; Cardim,
a 56.5% reduction in the IGF-I:IGFBP-I ratio (21.9 vs 9.53).No                 Hjp & Pinotti, Ja, Dept. OB/GYN, São Paulo University Medical
significant changes in basal plasma concentrations of fasting insulin or       School, São Paulo, Brazil
area under the insulin curve were observed in response to oral loading.
Conclusions                                                                    Objective: To study the effects of finasteride, an inhibitor of 5 a-
The present results show that clomiphene does not cause changes in             reductase, on some serum hormones levels in women with PCOS.
insulin resistance associated with PCOS but reduces plasma levels of           Methods: 31 women (mean age: 24,8± 3,8 ys) with PCOS were enrolled
IGF-I and increases those of IGFBP-I, with a consequent marked                 in the study. Setting: Outpatient endocrine department of an academic
reduction in the IGF-I:IGFBP-I ratio.                                          public tertiary hospital. Main outcome measures: In a double-blind,
                                                                               randomized assay the women were treated with finasteride (5 mg/d; n:
                                                                               20) or placebo (n:11) for 12 weeks. All women had their serum levels of
                                                                               luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin
                                                                               (PRL), testosterone, androstenedione, dehydroepiandrosterone sulfate
                                                                               (DHEAS), estradiol (E2) and progesterone performed at 0 and 12 weeks.
62                                                                                                                      MONDAY, SEPTEMBER 4

Results: No significant differences were seen between the two groups in      G®C transversion in codon 25 of TGF-b (Th3 cytokine). Finally, a
all hormones studied.                                                        transition A to G in exon 1 of TNF-R was investigated by SSCP.
Conclusions: In this assay, finasteride use for 12 weeks do not caused       Results: In LSIL there were high secretors of TNF-a (0.05) whereas
alterations on the hormones studied.                                         other cytokine polymorphisms did not show any significance. It was also
                                                                             observed that adenocarcinoma was associated with increased secretor
                                                                             phenotypes of TNF-a (P=0.000049) but there were no significant
FC1.25 GYNECOLOGICAL NEOPLASIAL: TUMOR BIOLOGY                               associations with IL-4, IL-6, IL-10, TGF-b and TNF-Rp60
                                                                             polymorphisms in LSIL, HSIL, squamous cell carcinoma or
FC1.25.01                                                                    adenocarcinoma of the cervix.
LOCAL CLUSTER OF DIFFERENTIATION ANTIGEN (CD) IN VIN                         Conclusions: TNF-a-308 polymorphism in which allele “A” is
Nahid KulKamal, Duddley Road Hospital, Birmingham, UK                        associated with high secretor phenotype appears to play an important
                                                                             role in pathogenesis of cervical lesions.
Aim: To study the CD antigen related changes in Vulval Intra-epithelial
Method: Histopathological features of VIN with regard to CD antigen          FC1.25.04
were studied by immunohistochemical method. Analysis of                      EVALUATION OF AN INTRON 2 POLYMORPHISM IN THE P53
histopathological specimen from vulval biopsies previously undertaken        GENE
for VIN with and without HPV, benign vulval disorders and SCC. 24            E. Høgdall1,2, L. Christensen1, C. Høgdall3,4, J. Blaakaer5, E. Glud1, J.
cases were included in the study. Demographic characteristics included       Vuust2, B. Nørgaard-Pedersen4, J. Bock3 and S. Krüger Kjaer1*.
age, smoking, symptom and immunosuppression.                                 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen,
Outcome measures: CD3, CD4; CD8 antigens and CD4/CD8 ratio                   Denmark1, Dept. of Gyn/obs, Rigshospitalet, Copenhagen, Denmark3,
Results:                                                                     Lab. of Mol. Biology2 & Dept. of Clin. Biochemistry, Statens Serum
1. CD8 population is increased in low grade VIN and benign vulval            Institute, Copenhagen, Denmark4, Dept. of Gyn/obs, Aarhus University
    disorders                                                                Hospital, Skejby, Denmark5. (*Principal investigator).
 2. No significant difference in cytotoxic Tc and helper Th cell in high
    grade VIN and SCC                                                        Objectives: The goal of the study was to examine the distribution of a
 3. Presence of HPV did not alter the presentation of CD4 and CD8            detected polymorphism in intron 2 of the p53 gene in blood and tissue
    antigen                                                                  samples from Danish ovarian tumour patients. Secondly, to correlate the
Conclusion: Increased T-cell cytotoxicity may be responsible for the         detected genotypes to biochemical and clinical data, and prognostic
arrest of disease progression in low grade VIN or loss of increased          variables.
cytotoxicT-cell activity may lead to progression of VIN.                     Study methods: In the MALOVA study, blood samples and
Association of HPV in disease progression can only be addressed in           corresponding tissues from 119 women were collected (101 ovarian
studies undertaking HPV typing. Phase two of this pilot study will           cancers and 18 borderline tumours).
continue with the use of immune modulators.                                  High molecular weight DNA was extracted from the EDTA-
                                                                             supplemented blood samples and from 106 tumour tissues (90 ovarian
                                                                             cancers and 16 borderline tumors). From 13 tissues, the chromosomal
FC1.25.02                                                                    DNA was not sufficient for the analyses. PCR reaction was performed
PREDOMINANT Th2/Tc2 POLARITY OF TUMOR-INFILTRATING                           on exon 2 through 3 of the p53 gene, and gave rize to a DNA fragment
LYMPHOCYTES IN CERVICAL CANCER                                               267bp in length. SSCP analysis was performed in a 20% acrylamide gel.
B.C. Sheu, S.C. Huang, Dept. OB/GYN, National Taiwan University              Sequencing of the PCR products identified the relevant polymorphism.
Hospital, Taipei, Taiwan.                                                    Results: A polymorphism, located at base 38 in intron 2 of the p53 gene,
                                                                             was detected giving rize to three distinguishable SSCP patterns. The A1
Objectives: Functional alterations of Tcl/Tc2 subsets in tumor               allele has a ”C”, while the A2 allele has a ”G” at this position in the p53
microenvironment may change the host anti-tumor immune responses.            gene. Significant differences were found between the distributions of the
The aim of this study is to investigate the polarity of tumor-infiltrating   genotypes in the investigated blood samples and corresponding tissue
lymphocytes (TILs) in cervical carcinoma.                                    samples from 90 ovarian cancers (P=0.0058).
Study Methods: We quantitatively measured and compared the subsets           Significant differences in survival were found between patients (stage
of lymphocytes infiltrating the neoplastic cervix. CD8+ T cells were         III/IV) with the genotype A1/A1 vs. the genotypes A2/A2 and A1/A2 in
isolated from TILs using a magnetic activated cell sorter. The cytoline      tissues (P=0.045).
expression patterns were measured by flow cytometry after activation         Conclusions: A significant difference in survival was found between 61
with intracellular staining.                                                 stage III/IV patients stratified for the intron 2 polymorphism. The above
Results: In triple-color flow cytometric assays, gated CD3+ T cells          results are part of an ongoing study, and results from a total of 200 cases
derived from TILs mainly expressed IL-4 and IL-5, but not IFN-g.             (blood and tissue) will be presented.
Further studies showed that the expression of these cytokines was not
restricted to a particular subset of T cells. IL-4 or IL-5 was detected in
both the CD4+- and CD8+-TIL subsets.                                         FC1.25.05
Conclusions: We demonstrated the first human evidence that activated T       EARLY DETECTION OF MALIGNANT CHANGES IN
cells in human cervical cancer milieu predominantly expressed polarized      PREMALIGNANT ENDOMETRIAL AND CERVICAL LESIONS
phenotype. Polarization toward Th2/Tc2 subsets may signify a down-           USING P53 IMMUNOSTAINING AND CYTOPHOTOMETRIC
regulation of the cytotoxic potential of TILs and/or render the tumor        STUDY OF DNA NUCLEAR CONTENT
cells resistant to TIL-mediated cytolysis.                                   Wafaa Farghaly Aref* and Neveen M. Nour El-Dine**Dept of
                                                                             Pathology* and OB/GYN** Minia University- Egypt

FC1.25.03                                                                    Objectives: Early detection of malignant changes in premalignant
CYTOKINE POLYMORPHISMS AND CERVICAL LESIONS                                  lesions of both endometrium and cervix, using P53 nuclear
G.S. Majeed, S. Glew, J. Bidwell, Dept. OB/GYN, University of Bristol,       immunostaining and cytophotometric technique for DNA nuclear
Bristol, UK.                                                                 contents.
                                                                             Methods: Forty seven endometrial and cervical biopsies from patients
Objectives: The aims of the study were to investigate a role of cytokine     suffering of pre or postmenopausal bleeding (18 simple & complex
polymorphisms in patients with different grades of cervical lesions.         endometrial hyperplasia with atypia 10 CIN, 12 endometrial carcinoma,
Methods: One hundred and forty-seven DNA samples from patients with          and 7 cervical carcinoma) and 12 control cases were evaluated by
different grades of cervical lesions were compared with 100 healthy, age     histopathology, P53 immuno-staining and DNA cytophotometric study.
and sex-matched bone marrow donors. Heteroduplex analysis was used           Results: Three cases (one simple, 2 complex) out of 18 atypical
to detect a G®A transition in TNF-a (Th1 cytokine), a G®A transition         endometrial hyperplasia (16.7%) both with atypia were aneuploid and
in IL-10 and a G®C transversion in IL-6 (Th2 cytokines). RFLP was            showed positive P53 immunostaining (malignant criteria). Two cases out
used to detect a C®T transition in IL-4 promoter (Th2 cytokine) and a        of 10 CIN (20%) were aneuploid and 4 were positive P53 immuno-
MONDAY, SEPTEMBER 4                                                                                                                                   63

staining (40%). Aneuploidy and P53 immunostaining were directly              CR-1 can increase vimentin expression and enhance migration in human
proportional to the tumour grade in both endometrial and cervical            cervical cells.
carcinoma with increasing aneuploidy and staining positivity in higher
than lower tumour grades.
Conclusion: Adding P53 immunostaining or cytophotometric study to            FC1.25.08
histopathology in cases of atypical simple and complex endometrial           LAPAROSCOPY HAS NO EFFECT ON TUMOR CIRCULATING
hyperplasia and CIN will help in early detection of malignant changes        DNA
for better operative and post operative management. Both methods may         F. Lécuru, A. Agostini, M. Aggerbeck, JP. Jaïs, F. Vildé, R. Taurelle,
help in measurement of the power of invasion and tumour                      Service Gynécologie, Hôpital G Pompidou, Paris, France
aggressiveness in frank endometrial and cervical malignancy for better
evaluation of operative and postoperative management.                        Objectives: To evaluate the effect of laparoscopy on tumor circulating
                                                                             Study Methods: Laparoscopy, gasless laparoscopy, midline laparotomy
FC1.25.06                                                                    or general anesthesia were randomly carried out on 2 xenografts of
EXPRESSION AND FUNCTION OF CRIPTO-1, A MEMBER OF                             ovarian cancer in nude rats: IGR-OV1 or NIH: OVCAR-3. Circulating
THE NEW EGF-CFC PEPTIDE FAMILY, IN NORMAL                                    DNA was extracted and amplified (PCR with primers specific of human
SQUAMOUS EPITHELIUM, IN CERVICAL INTRAEPITHELIAL                             DNA). Statistics used Wilcoxen test and Chi squared test.
(CIN) LESIONS, AND IN CERVICAL CANCER                                        Results: 18 rats were included in each group. Our protocol could detect,
A.D. Ebert, C. Wechselberger, J.M. Stieler, C. Bianco, G. Schaller, A.       specifically, 10 cells/ml of healthy rat blood. In the IGR-OV1 model,
Hagen, H. Weitzel, D.S. Salomon, Dept. OB/GYN, UK Benjamin                   circulating tumor DNA was observed in 45 to 50% of rats without
Franklin, Free University Berlin, Berlin, Germany                            significant difference between groups. In the NIH: OVCAR-3 model,
                                                                             detection rate ranged from 22% (control group) to 64% (gasless group)
Objectives: Cripto-1 (CR-1) transphosphorylates erbB-4 and activates         (p=0.04)
the ras/raf/MEK1/MAPK-pathway through a novel receptor.                      Conclusions: In this experimental trial, CO2 laparoscopy had no
Additionally, CR-1 can function as a survival factor through the             deleterious impact on circulating tumor DNA.
phosphatidylinositol-3 kinase-dependent phosphorylation of Akt and
glycogen synthase kinase-3b (GSK-3b) in human cervical carcinoma
cells.                                                                       FC1.25.09
Study Methods                                                                THE CONSTRUCTION, EXPRESSION AND ACTIVITY
1) Cell culture (primary human keratinocytes, HPV 16-immortalized            EXAMINATIONS OF 6B11ScFv/MURINE GM-CSF FUSION
   keratinocytes, cervical carcinoma cell lines), Western blot (WB);         PROTEIN
2) Retrospective clinical study (normal squamous epithelium [n=18],          H.Cui, B.Liu, J.Feng, H.Qian, Gynecologic Oncology Center, People¡¯s
   cervical intraepithelial neoplasia [n=27], cervical cancer [n=70],        Hospital, Beijing Medical University, Beijing, China, 100044.
   immunohistochemistry (IHC).
Results: Using WB, CR-1 was detectable in 37.5% of primary                   Objectives: To construct expression vector which expresses fusion
keratinocytes, in 94.1% of immortalized keratinocytes, and in 84.6% of       protein of anti-idiotypic single chain antibody 6B11ScFv and murine
cancer cell lines. As evidenced by IHC, CR-1 was over expressed in           GM-CSF (6B11mGM) for observing its possible immune reactions in
cervical carcinomas (p2=0.0001). There was no statistically significant      vivo.
correlation between CR-1 expression and FIGO stage, grading, lymph           Methods: Using DNA recombinant techniques, the murine GM-CSF
node involvement. In CR-1 over expressing malignancies, a trend to           cDNA gene was recombined to 6B11ScFv and they were cloned into
better survival was observed.                                                expression vector pET-30a(+) to produce insoluble protein. Inclusion
Conclusions: In summary, CR-1 is over expressed in human HPV 16-             bodies collected after the breakage of bacteria through sonication were
immortalized keratinocytes and cervical carcinoma cells, but also in         subjected to repeatedly washing. Inclusion bodies solubilized in the
human primary cervical cancer. Therefore, CR-1 re-expression might           presence of 8 mol¡¤L-1 urea were diluted with renaturation solutions so
play a significant role in human cancer pathophysiology.                     that folding process could be initiated. The purity was examined by
                                                                             SDS-PAGE, ELISA and cell proliferation assay were used to determine
                                                                             the activities of fusion protein.
FC1.25.07                                                                    Results: 6B11mGM fusion proteins were obtained with a purity of over
EFFECT OF CRIPTO-1 (CR-1) ON MIGRATORY BEHAVIOR AND                          90%. The optimum conditions were 1mmol¡¤L-1 and 5 mmol¡¤L-1 for
VIMENTIN EXPRESSION OF HUMAN CERVICAL CARCINOMA                              the concentrations of GSSG and GSH, respectively, with 48 hours at
CASKI CELLS                                                                  10oC as renatured time. Fusion protein could specifically react with the
A.D. Ebert, C. Wechselberger, B. Wallace-Jones, M. Nees, T. Clair, C.        primary anti-ovarian carcinoma monoclonal antibody (COC166-9) and
Bianco, H. Weitzel, D.S. Salomon, Dept. OB/GYN, UK Benjamin                  rat anti-mouse GM-CSF monoclonal antibody, respectively, and fusion
Franklin, Free University Berlin, Berlin, Germany                            proteins could also stimulate murine GM-CSF dependent cell line NFS-
                                                                             60 cells to proliferate.
Objectives: CR-1, a member of the new EGF-CFC family of proteins, is         Conclusion: Fusion proteins 6B11mGM expressed as inclusion bodies
an extra-cellular growth factor that holds important roles during early      can keep the activity of both the proteins and provide foundation to
vertebrate development, and was shown to be re-expressed in several          research the immunoreactions in vivo.
human types of cancer.
Study Methods: Cell culture, human Caski cervical cancer cell line,
cDNA gene expression array, Western blot, indirect                           FC1.26 INTERVENTIONS IN LABOR
immunofluorescence, Boyden chamber assay.
Results: An increase of in vimentin expression was demonstrated in CR-       FC1.26.01
1 transfected Caski cells as compared to vector-transfected cells            DELIVERY ROOM EXPERIENCE OF A PALM PUMP VACUUM
(controls). In untransfected, parental cells, recombinant CR-1 induced a     DELIVERY SYSTEM. A COMPARATIVE AUDIT.
dose-dependent increase of vimentin expression within 24 hours. Since        R Hayman, D Smith, S Arulkumeran. Derby City General Hospital,
vimentin expression has been demonstrated to correlate with a more           University of Nottingham, UK.
aggressive phenotype in human cervical cancer, migration of CR-1
transfected or CR-1 treated Caski cells was studied in the Boyden            Objectives: Assisted vaginal delivery is an integral part of obstetric care
chamber assay. Compared to vector-transfected or untreated cells, CR-1       worldwide. Whilst generally safe, such deliveries are often complicated
transfectants or cells treated with recombinant CR-1 exhibit significantly   by faulty equipment, and are dependent on the accoucheur having a fully
enhanced migration, both, through collagen- and gelatin-coated               trained assistant. The Kiwi OmniCupTM palm operated vacuum delivery
membranes.                                                                   device provides an integral unit designed for complete control without
Conclusions: The findings are of biological significance since Cr-1 is       an assistant. We wished to assess the degree of effectiveness and
over expressed in human cervical carcinomas. The data demonstrate that       incidence of complications associated with this device in a delivery
                                                                             room setting.
64                                                                                                                       MONDAY, SEPTEMBER 4

Study Methods: A retrospective case note audit of patients requiring an      Study Methods: Five hundred and eleven Barton’s forceps procedures
assisted vaginal delivery was performed between August and October           (0.74%) of deliveries are related to three thousand and fifty-two
1999. All patients delivered by ventouse during this period were             ventouse deliveries (4.7%) eighty seven Kielland’s forceps deliveries
included in the study, and comparisons in maternal and fetal outcome         (0.13%) and 5, 061 (7.33%) cesarean section deliveries.
made between those delivered using the OmniCupTM and those with the          Results: The ventouse was used in the majority of assisted deliveries.
standard silastic or metal cups. Choice of instrumentation was made at       When this was unsuccessful, (68 cases) the procedure was completed
the time of delivery by the accoucheur.                                      with the Barton’s forceps. The Kielland’s forceps were progressively
Results: Of the 1142 women delivered during these months, 133                replaced by the Barton’s. Poor bearing down after epidural block gave
(11.6%) required an assisted vaginal delivery. 46 (34%) were delivered       preference to the Barton’s. In deep transverse arrest of the head, the
using the OmniCupTM the remainder with standard equipment. There             Barton’s was the assisted delivery of choice.
were no significant differences between the groups in the demographic        Conclusion: Experience in using Barton’s forceps for mid-pelvic arrest
details (including gestation, birthweight & fetal presentation); rates of    of the fetal head in 511 cases has proved that this instrument is both easy
successful vaginal delivery (89% vs. 86%: p=0.8); perineal trauma (1st &     to apply and safe for the baby, provided rigid adherence to safety criteria
2nd degree tears + episiotomies: 87% in both groups); or major fetal         is observed. As modern obstetric practices favorably disposed towards
injuries including cephalhematoma, subgaleal haematoma, HIE, &               mid-pelvic forceps vaginal delivery, the particular advantages of
severe jaundice: p>0.18 all comparisons). However, procedures                Barton’s forceps should be more widely extolled. Their use is an
performed using the OmniCupTM required an extra contraction / traction       invaluable addition to the obstetrician’s armamentarium. Training in
prior to delivery (3 vs. 2: p<0.05), and resulted in an increase in minor    their use should, however, be thorough and extensive and under the
fetal injuries such as abrasions (24% vs. 7.5%: p=0.03) and bruises          guidance of a skilled senior obstetrician.
(19.5% vs. 9%: p=0.06).
Conclusions: The Kiwi OmniCupTM provides a safe addition to standard
delivery room vacuum equipment. In addition, those using the device          FC1.26.04
found it to be ‘user friendly’ and easy to manipulate into the correct       HISTORY OF THE PARTURITION CHAIR
position.                                                                    A. Alaily, Dept. of OB/GYN, Conquest Hospital, East Sussex, UK

                                                                             Objectives: To investigate the use of the parturition chair throughout
FC1.26.02                                                                    history and its relevance in modern obstetric practice.
CONDUCT OF LABOR AND RUPTURE OF THE SPHINCTER ANI                            Study Methods: The positions for delivery from antiquity to the present
C. Parnell*, J. Langhoff-Roos*, H. Moller**.                                 day, and in different countries and cultures, were studied, including
*Dept Obstetrics, Rigshospitalet, University of Copenhagen, Denmark.         verbal accounts from local women.
**Thames Cancer Registry, Kings College, London, UK.                         Results: The Egyptians were first to demonstrate the birthing chair. It
                                                                             also flourished in the heydays of Greece and Rome but was almost
Objectives: To determine whether the conduct of the second stage of          forgotten in the darkness of the earlier centuries of the Christian era. It
labour and delivery technique influences the incidence of rupture of the     seems to have survived in Italy and found its way across the Alps into
anal sphincter.                                                              Germany and France. There is certainly a great popularity in the sitting
Study Methods: A total of 1072 primipara delivered vaginally at term at      position, or squatting position, to give the chair a place in our current
Rigshospitalet in 1998. Immediately after delivery 90 cases with rupture     environment. Eighty chairs will be shown from antiquity to the present
of the sphincter and in two subsequent controls for each case (n=164)        day.
matched by use of vacuum extractor and episiotomy, a questionnaire on        Conclusions: One of the foundations of the history of medicine is the
prenatal risk factors, conduct of the second stage of labour, and delivery   manner in which old customs are revived and this certainly may be the
technique was filled in.                                                     case with the parturition chair.
Results: Partial or total sphincter rupture was found in 8.3% of primipara
who delivered vaginally, in 20.9% of those delivered by
vacuumextraction, and in 6.4% of those with episiotomy only.                 FC1.26.05
The prenatal risk factors – maternal age, birth weight, shoulderdystocia,    TRENDS IN OBSTETRIC INTERVENTION IN THE UNITED
and oedema of the perineum – were found to have a statistically              KINGDOM
significant effect on the incidence of rupture of the sphincter ani.         MP O’Connell & SW Lindow, Academic Department of Obstetrics &
In unassisted vaginal deliveries easing of the perineum over the caput as    Gynaecology, University of Hull, Hull Maternity Hospital, Hedon Road,
it advanced helped prevent a rupture of the anal sphincter.                  Hull HU9 5LX UK.
Vacuumextraction performed with the woman in a semi-recumbant
position was associated with an increased risk of rupture of the anal        Objectives: The aim of the study was to identify trends in obstetric
sphincter, whereas attention to the perineum during extraction decreased     intervention in the UK, utilising the annual statistical returns of the
the risk.                                                                    Royal College of Obstetricians and Gynaecologists (RCOG).
Conclusions: The significant effect of prenatal risk factors did not         Methods: The most recently published returns by the RCOG (1993 &
explain a correlation between delivery technique and rupture of the          1994) were compared with the returns for 1997/98 of 222 Obstetric units
sphincter ani. The present study implies that a reduction in the incidence   in the UK. The 1997/98 results were obtained following a manual search
of sphincter rupture can be accomplished by improved obstetric care:         in the RCOG of the 222 individual unit returns.
less vacuum extractions and improved delivery technique.                     Results: There has been an increase in Caesarean section rates (15.63%,
                                                                             16.21%, 18.61%) over the study period, mirrored by a decrease in
                                                                             normal vaginal delivery rates (71.83%, 70.77%, 69.54%). The
FC1.26.03                                                                    Caesarean section rates for breech presentation have increased (1.99%,
AFRICAN RENAISSANCE OF THE ORIGINAL AMERICAN                                 2.43%, 2.76%). Instrumental delivery rates have remained relatively
FORCEPS (THE BARTON’S)                                                       constant (10.14%, 10.92%, 10.73%), with a continuing trend towards
V.P De Villiers, Dept. OB/GYN, Paarl Hospital, Paarl, Republic of            increase use of the vacuum extractor over the forceps. Epidural use in
South Africa.                                                                labour (24.61%, 24.71%, 23.07%) and induction of labour rates
                                                                             (22.22%, 22.96%, 24.79%) have remained constant over the study
Objectives: The aim of the study is to evaluate the place of anterior-       period.
posterior forceps.                                                           Conclusion: The instrumental delivery, epidural and induction rates have
Barton’s forceps are the only true American forceps. The concept was         remained relatively constant during the study period. Caesarean section
first developed in 1911 by Dr. Layman Guy Barton, a qualified                rates have increased resulting in a decrease in normal vaginal deliveries.
mechanical engineer who later graduated as a doctor in order to follow       Despite the RCOG audit recommendation that all uncomplicated term
in the footsteps of his father who practiced as a general practitioner in    pregnancies with a breech presentation should be offered external
Willsboro, Essex County, New York. The forceps are unique as they are        cephalic version, there has been an increase in the Caesarean section rate
the only example of an anteroposterior instrument, i.e. forceps designed     for breech presentation.
specifically for grasping the fetal head in the transverse position.
MONDAY, SEPTEMBER 4                                                                                                                                   65

FC1.26.06                                                                     rotational ones; in all known indications, presentations, positions, except
IS INTERNAL PODALIC VERSION (IPV) - A LOST ART?                               shoulder dystocia, including paradoxical use at C-sections for floating,
V. Raut, Dept. OB/GYN, GSMC & KEM Hospital, Mumbai, India.                    deep or after-coming head; mainly with local anesthesia and
                                                                              orientational episiotomy) confirmed safety and advantage with the
Objectives: To compare IPV v/s cesarean section for the management of         versatile Hay’s forceps.
transverse lie.                                                               The instrument is short-long, straight (rotational) – bendable (promoting
Study Methods: A retrospective study over 12 years included 104               flexion with built-in axis traction); light-sturdy; parallel-divergent;
patients with transverse lie in labor. The age, parity, mode of delivery,     spring steel-aluminum; with narrow retro-pelvic curve blades; unique
maternal and neonatal outcome were noted.                                     ‘spud-in-grove’ lock for safety, adaptation to asynclitic heads with small
Results: The study was divided in two parts of 6 years each. In the first     or large bi-parietal diameters.
half 35.4% and 64.6% were delivered by IPV and cesarean section               While the science requires continuous review with standardization of
respectively. In the second half 15.8 and 84.2% were delivered by IPV         involved entities, the art needs to be re-established by in-depth teaching
and cesarean section respectively. Neonatal survival was better with          programs for residents and practicing obstetricians.
cesarean section (130/137, 94.8%) compared to IPV (8/19, 42.1%).              Non-availability of the forceps has been a vexing issue because of the
Conclusions                                                                   complexities involved in manufacture, the death of the innovator and the
1. Increased incidence of cesarean section in the latter half of the study    need to wait for scientific documentation to establish safety and efficacy.
   was because of availability of improved neonatal facilities.               The effort, wait has extended over the last quarter of the 20th century.
2. Cesarean section is a better option than IPV for a salvageable fetus in    The atlas monograph and the instrument now require universal
   transverse lie.                                                            examination. This should contribute to updating of the subject and the
3. IPV still has a role in the management of a dead baby in transverse lie    instrument in the new millennium.
   and for second of twins in developing countries.

FC1.26.07                                                                     BREECH PRESENTATION – VAGINAL DELIVERY OR
FORCEPS REVIVAL                                                               G. Gregoric, G. Hajdukovic, D. Papic, N. Todorovic, F. Djordjevic,
S.Gupte (1), A.Gupte (1), U.Subramaniam (2), A.Mulay (2), (1) B.J.            J. Ristic, Dept. OB/GYN, Clinical center "'Zvezdara,” Belgrade,
Medical College, 894 Bhandarkar Road, Pune, Maharastra, 411004, (2)           Yugoslavia.
Gupte Hospital Research Center, Pune, Maharastra, India.
                                                                              Objectives: The aim of the study was evaluate outcome (mortality and
Objectives: Hay’s forceps with its short-long, parallel, straight-bendable,   neonatal morbidity) of deliveries in breach presentation and to compare
narrow blades, light weight but sturdy construction & ability for             the results by route of delivery vaginal or Cesarean Section.
rotation-flexion, seemed an ideal instrument. We studied the atlas            Study Methods: Retrospective analysis of breach presentation for five
monograph * and evaluated the use of Hay’s forceps in 212 deliveries,         years period 1995-1999. 301(2.88%) breach presentation from total
over a period of 4 years, in our Hospital.                                    10,431 deliveries form study group. The evaluation took in consideration
Results: -----The findings are presented here.                                parity, gestational age, fetal macrosomy, complete or incomplete breach
Gravidity-> Primi-176(83%). Multi-36(17%). The presentation was               presentation, Apgar score, neonatal morbidity and mortality. Statistic
vertex in all.Labour was spontaneous in 156 cases, induced in the rest. A     test used: c2 test.
trial of forceps was carried out in 11.The anasthesia was either              Results: For total of 10,431 deliveries 1144 Cesarean Section were
local/pudendal. Indication->Fetal bradycardia-22(10.38%). Non                 preformed (10.96%) in the group of breech presentation Cesarean
reassuring trace on fetal monitor -106(50%). Maternal exhaustion-             Section were preformed in 119 cases (39.5%) versus 182 (60.4%) breech
36(16.98%). Prophylactic-48(22.64%). Fetal Position on application-           vaginal deliveries with a mean duration of labor of 5.2 hours. In the
>OA-94(44.34%). LOA 52(24.53%). ROA-37(17.45%). LOT-                          study group 239 (79.4%) were delivered at term, 62 (20.5%) were
19(8.96%). ROT-4(1.89%). OP-6(2.83%). Level of application-> Outlet-          preterm, 253 (84,05%) were complete breech, and 48 (15.9%) were
96(45.28%). Low <450 rotation-89(41.98%). Low>450 rotation-                   incomplete breech. Neonatal mortality and morbidity in vaginal versus
23(10.85%). Mid-4(1.89%). Application & Locking-> Difficult-                  Cesarean Section deliveries were the main out come measures. Apgar
44(20.75%). Easy-168(79.25%). Extraction-> Easy-196(92.45%).                  score for first minute less than 6 (11.9%), from 6 - 8 (6.8%), more than 8
Difficult-14(6.60%). Failed forceps-2(0.94%). Baby weight ranged              (21%). According to neonatal weight: less than 2.500kg 49 (16.6%),
between 1750 grams and 3900 grams. Apgar Score at 1 minute-> Below            over 4.000 kg 21(6.97%), mean neonatal weight 2.900 kg. Total
5-26(12.26%). Above 5-186(87.74%). Post Forceps Fetal Morbidity->             traumatic morbidity of babies in breach presentation was 54 (17%), in
Deep forceps mark-52(24.53%). Cephal haematoma-6(2.83%).                      vaginal deliveries 36 (11.7%), versus Cesarean Section 18 (5.9%) (c2 =
Contusion-7(3.3%). Periorbital oedema-8(3.77%). Convulsions-                  1.058, P = 0.303). Traumatic mortality in breech presentation was
1(0.47%). Post Forceps Maternal Morbidity-> Collapse-Nil Atonic PPH-          0.99%.
4(1.89%). Traumatic PPH-16(7.55%). Small vaginal tears & Epi.                 Conclusion: An elevated traumatic neonatal morbidity in breach
extension-116(54.72%). Large tears & fornicial extension-29(13.68%)           presentation, especially in babies under 2.500 kg of weight and in
Cervical tears-18(8.49%). Spiral tears-2(0.94%). Anal injury-2(0.94%).        macrosomic babies explains an elevated percentage of Cesarean Section
Other tears - contralateral-14(6.60%). Periclitoral tears-2(0.94%).           in breech presentation (c2 = 259.04, P = 0.0).
Urinary retention as late complication-4(1.89%).
Conclusion : From the foregoing, it can be concluded that Hay’s Forceps
is a safe & effective instrument for routine use. For which it seems an       FC1.27 INTRAPARTUM AND POSTPARTUM INFECTION
ideal instrument. It is the need of the hour to get younger Obstetricians
reintroduced to the role of obstetric forceps in modern obstetrics.           FC1.27.01
Ref: Atlas Monograph on his Forceps by S.N. Nargolkar                         ENDOCERVICAL CULTURES IN THE PREDICTION OF
                                                                              SUBCLINICAL INTRAAMNIOTIC INFECTION IN PRETERM
                                                                              PRELABOR RUPTURE OF THE MEMBRANES
FC1.26.08                                                                     D. Vaitkiene, Dept OB/GYN, Kaunas Medical University, Kaunas,
HAY’S FLEXION-ROTATION, SHORT-LONG OBSTETRIC                                  Lithuania
S.M. Nargolkar, Indira Maternity Home, Pune, India                            Objectives: The aim of the study was to study endocervical flora in
                                                                              women with preterm prelabor rupture of the membranes in an attempt to
Objectives, study methods, results and conclusions have been presented        elucidate potential relationship of these microorganisms to those found
in international journals, congresses and included in the author’s ‘Hays      in amniotic fluid.
Forceps’ – an atlas monograph, published by Penham Inc. Philippines.          Study Methods: 75 pregnant women with 22-36 completed weeks of
This work has been reviewed by the Canadian and Asian Journals.               gestation volunteered to participate in the study. Endocervical swabs
The Hay-Nargolkar counter-current, prospective, collaborative multi-          were taken for aerobic culture and detection of C. trachomatis.
center studies (with upward of 2000 operations including mid-cavity and       Amniocentesis was performed and amniotic fluid was cultured for
66                                                                                                                       MONDAY, SEPTEMBER 4

aerobic bacteria and C. trachomatis. The sensitivities and specificity of     FC1.27.04
genital tract colonization in the prediction of amniotic fluid infection      ANTIBIOTIC PROPHYLAXIS IN CAESAREAN AND OPERATIVE
were calculated.                                                              VAGINAL DELIVERY
Results: Isolation of microorganisms in genital tract culture predicted       M.L. Canete, A. Jimenez, A. Monorobel, D. Maldonado, J.M. Sanchez,
82% of sub-clinical intraamniotic infection with false positive rate of       P. Lafuente, M.V.Bravo, A. Sanchez-Dehesa, Dept. OB/GYN, Hospital
75% and positive predictive value of 57%. The finding that cultures           Virgen de la Salud, Toledo, Spain
from the lower genital tract provide poor prediction of intrauterine
infection, suggest that other factors, apart from mere colonization of the    Objectives: To analyze the effect of prophylactic antibiotics on
lower genital tract, are implicated in rupture of the membranes an            postpartum local infections (endometritis and wound infections)
intrauterine infection.                                                       following caesarean or operative vaginal deliveries.
Conclusions: Our findings suggest that clinical management of                 Methods: We included all caesarean and operative vaginal deliveries that
pregnancies with preterm prelabor rupture of the membranes should not         occurred in 1999 and analyzed the incidence of endometritis and wound
rely on the results of cultures of swabs from the lower genital tract.        infections. A total of 508 caesarean sections, 192 forceps and 20 vacuum
                                                                              extraction deliveries were included. The antibiotics used were either
                                                                              three-doses of cefazolin or a single dose of cefminox. Antibiotic
FC1.27.02                                                                     prophylaxis was administered in 80% of caesarean deliveries (23.7%
ANTIBIOTICS USE: CAN WE REDUCE IT?                                            received three-dose cefazolin and 37% single-dose cefminox). In the
B. Ghosh, Dept. OB/GYN, Burnpur Hospital, Burnpur, West Bengal,               operative vaginal groups, 57% received prophylaxis (32% cefazolin
India.                                                                        versus 30% cefminox). A logistic regression analysis of the data was
Objectives: Antibiotics are the most commonly used drugs in any clinic        Results: The incidence of postpartum infection after a caesarean section
or hospital throughout the world. Though it is now well-established           was 5% following the antibiotic prophylaxis and 8.8% without it
beyond reasonable doubt that antibiotics are widely misused and               (p=0.36). The incidence of postpartum infection after operative vaginal
overused, more so in the name of surgical prophylaxis, these are              delivery was 2.5% without prophylaxis and non-existent following
routinely used in our O&G practice in almost all surgical procedures          antibiotic prophylaxis (p=0.63). We didn’t find significant differences
without any audit or statistical evaluation. Keeping this in view and         between single versus three-doses prophylaxis.
supported by various references, a prospective study was undertaken to        Conclusion: Although we didn’t find a statistically significant
find out whether the practice of routine use of antibiotics is necessary in   difference, the decrease in the incidence of postpartum infection after
all such cases.                                                               antibiotic prophylaxis (3.8%) seems to have at least clinical significance.
Study Methods: Out of a total 525 cases, 387 cases of major (abd              Single-dose cefminox was as effective as three-dose cefazolin, but at the
hysterectomy, C. section), medium (Dx laparoscopy, tubal sterilization),      same time, it was easier to use and the cost per use was reduced.
and minor (episiotomy) operations were included in the study without
using any antibiotics, taking certain pre, intra and post operative
measures.                                                                     FC1.27.05
Results: 45.8% of major operations and 75-80% of medium and minor             FEATURES OF ANTIBACTERIAL THERAPY INTRAAMNIOTIC
operations did not require antibiotics. Comparative analysis showed           INFECTIONS.
6.3% incidence of wound infection in no-antibiotic group against 9.5%         P.V. Budanov, O.R. Baev, Z.M. Musaev, Dept. ob/gyn, Moscow
in use-antibiotic group, though incidence of urinary tract infection was      Medical Academy, 4 Kolomensky proezd, Moscow, Russia
16.2% against 14.8% respectively. Post-operative hospital stay was
observed similar in both the groups.                                          Objectives: The aim of the study was evaluate efficiency of various
Conclusions: Routine mass scale and indiscriminate use of antibiotics         ways of treatment intraamniotic infections, provoked by M.hominis,
should be avoided.                                                            M.genitalis, U.urealiticum.
                                                                              Study methods: There was randomized prospective examination of 93
                                                                              patients with intraamniotic infections, provoked by M.hominis,
FC1.27.03                                                                     M.genitalis, U.urealiticum. The investigation included general
STUDIES INTO AMNIOTIC FLUID IN CHORIOAMNIONITIS                               examination, bacteriological methods, DNA-tests, ELISA, with
A. Patrascu, L. Surtea, S. Berceanu, M. Banita, University of Medicine        determination of the YgG, YgM level. The was dynamical ultrasound
and Pharmacy, 4, Petru Rares street, Craiova, Dolj, Romania, 1100.            examination, Doppler uteroplacental blood flow velocimetry. No
                                                                              patients had HIV-infection, syphilis, rubella, thoxoplasmosis, OPH-
Objectives : We intended to perform bacteriological and immunological         hestosis. 29 patients got therapy of erythromycin, 28 - josamycin, 36 -
studies into amniotic fluid in chorioamnionitis. We perform some tests        azithromycin in standard doses.
in vitro concerning the inhibiting power of amniotic fluid in relation to     Results: 37.9% of the patients showed clinical efficiency when
the time of membrane breaking. At the same time our study analyses IL         erythromycin was used. When azithromycin and josamycin were used
6 and IL 8 and the degree of bacterial invasion from the same sample in       the patients showed 61.1% and 71.4% accordingly. In comparison with
87 cases.                                                                     azithromycin when josamycin was used, the rate of elimination of
Study Methods : The tests were made on two bacterial strains: E coli -        clinical symptoms decreased by 35.4%. Mycrobiological convalescence
strain K27801 and ST aureus- strain ST27906. From these a bacterial           criteria for erythromycin were reached in average 11.7 days, for
suspension was made and put into contact with amniotic fluid collected        azithromycin - in 7.4 days, for josamycin - in 5.2 days. If there was
at variable time intervals after the breaking of the membranes. At the        reinfection, the period of microbiological and clinical normalization
same time, the concentration of germs was measured in amniotic fluid          reached average for erythromycin 3.3 weeks, for azithromycin 9.4 weeks
samples. IL6 and IL8 were determined in the amniotic fluid by means of        and for josamycin 11.2 weeks.
the ELISA test and the levels were compared with the bacterial invasion       Conclusions : For treatment of intraamniotic infections, provoked by
of the amniotic fluid.                                                        M.hominis, M.genitalis, U.urealiticum the first medicine are macrolides
Results : The results point to the fact that over time the bactericidal and   josamycin and azithromycin. There showed be a preference for
bacteriostatic capacity of amniotic fluid decreases, as the bacterial         josamycin taking into consideration that it's more safe during pregnancy,
colonisation increases. IL-6 and IL-8 in the samples of amniotic fluid        can be prescribed at earlier stages of pregnancy and its results were
increase evidently after 12 hours from the breaking of the membranes;         better after investigation.
and this is especially the case for IL-6.
Conclusions : The bactericidal capacity of the amniotic fluid decreases
over time after the breaking of the membranes. IL- 6 increases evidently
in infected amniotic fluid.
MONDAY, SEPTEMBER 4                                                                                                                                    67

FC1.27.06                                                                      bacteriologic ones, in order to determine the presence of toxins and anti-
PROPHYLAXIS OF POSTPARTUM PURULENT-                                            bodies against bacteria distributed most of all in patients.
INFLAMMATORY COMPLICATIONS.                                                    A certain definite role is attributed to blood coagulation system
L.I.Karpan, L.Martynova, N.Novikova, National Medical University,              connected with local immune status according to the period of
Ribalska 10, 5, Kiev, Ukraine, 01011.                                          pregnancy and the alteration of circulating and fixed immune complex
                                                                               of cytotoxic action.
The clinical–statistical analysis of 2125 delivery medical records for         The present paper is an attempt to elucidate one of the causes of
1997, among which 62 post-delivery women had postpartum                        pathogenesis of pathologies such as gestosis and atonic uterus blood
purulent–inflammatory complications. Data on women with Cesarean               loss.
section were not included.                                                     Study of microstructure of myometry and liver tissue in patients
Following factors were taken into consideration: age, social status,           revealed accumulation of a great quantity of fibrine fiber and fibrous
hazardous habits, existence of the extra-genital and gynecological             thrombus between myometry of perivascular and interstitial gaps,
diseases, number of abortions, whether pregnancy and delivery were             associated with cell membrane in the form of layer with dissociated
complicated in the given women group.                                          myocites. Morphologically, hypercaogulemia is expressed in the cortical
Results: Delivery was complicated in 50% of postpartum women by                substance of liver in the form of derangement of intravascular
lactation mastitis, in 6,66% - by uterus sub-involution, in 16,66% - by        coagulation and appearance of microthrombuses.
postpartum metro-endometritis; by stitch divergence of the episiotomic         Prophylactic application of antibacterial preparations and namely of
wound – in 13,66%, of lochiometr – in 3,33%; by placental polyp in             modulators Plaferon and Geparin in 6 pregnant women with liver
3,33%. Combination of the postpartum complication was seen in                  pathology and hypercoagulemia helped to avoid develpment of gestosis.
13,33% of postpartum women. The most pronounces risk factors in the            Study of a microstructure of miometry in this group of pregnant women
development of the postpartum purulent – inflammatory complications            did not reveal the above stated changes (studies were conducted when
were the following: professional hazards, existence of the chronic             the births ended with Cesarean section).
infection reservoirs of the genital and extra-genital infection, aggravated
obstetric-gynecological anamnesis on the background of extra-genital
pathology, complicated delivery.                                               FC1.28 PERINATAL MORTALITY
Conclusions: Data of the applied method gave the possibility to predict
postpartum purulent – inflammatory diseases and the timely introduction        FC1.28.01
of the prophylaxis measures decrease the frequency of this pathology by        PERINATAL DEATHS IN THE DONETSK REGION, UKRAINE
10%.                                                                           AND IN DENMARK.
                                                                               Boedker B, Mogilevkina I, Langhoff-Roos J, Larsen S, Lindmark G, and
                                                                               Orda A.
FC1.27.07                                                                      Rigshospitalet University hospital, Copenhagen, Denmark. Donetsk
USE OF LOCHIA CYTOLOGIC EXAMINATION FOR THE                                    State Medical University, pr.Ilicha, Donetsk, Ukraine. Hvidovre
EVALUATION                                                                     University Hospital, Copenhagen, Denmark. Uppsala University
L.Martynova, L.Karpan, National Medical University, Geroyev                    Hospital, Sweden. Donetsk Health Care Administration, Ukraine.
Stalingrada 41, 2, Kiev, Ukraine.
                                                                               Objectives: To analyse and compare which subgroups of perinatal deaths
The internal surface of uterus after the separation of afterbirth is a great   contribute to perinatal mortality (PM) in the Donetsk Region, Ukraine
wound surfase. Among the objective criteria of wound process course            and in Denmark.
evaluation cytologic examination takes an important place. This method         Study Methods: All cases of perinatal deaths of non-malformed infants
is a reliable and technically simple mode of uterine state evaluation.         in the Donetsk region 1997-98 and Denmark 1996 were identified by
When evaluating the results 5 types of cytograms are distinguished:            local and national registers and classified according to the Nordic Baltic
necrotic, degenerative-inflammatory, inflammatory-regenerative,                Perinatal Death Classification. Case reports were studied, and potentially
inflammatory, regenerative.                                                    avoidable deaths were identified, and differences in perinatal health care
The course of puerperium in healthy puerperas and women with risk              and organisation in the two countries were described.
factors of puerperal purulent-septic complications development was             Results: The perinatal mortality rate in Donetsk 1997-1998 was
studied. Among risk factors the iron deficiensy anemia usually occurred.       16.1/1000. In Denmark 1996 it was 8.0. When subgroups were
On the 3rd day of puerperium the inflammatory type of cytologic smear          compared it was found that antenatal death-rates of single normal-weight
was characteristic for puerperas. Such type of cytogram suggests the           fetuses were the same in the two regions (OR 1.0). Subgroups with
normal course of the first phase of wound process-inflammation phase.          higher mortalities in the Donetsk region were antenatal deaths of growth
The inflammatory reaction in endometrium is obviously caused by                retarded infants (OR 2.6), intrapartum deaths (OR 2.7) and neonatal
mechanical injury due to placental detachment as well as the presence of       deaths of term infants with normal Apgar scores (OR 2.2). Finally,
decidual tissue residues in uterine cavity.                                    neonatal mortality of infants with low Apgar scores was much higher in
On the 5-6th day the inflammatory-regenerative type of cytogram                the Ukraine (OR 15.6 for preterm infants, OR 4.6 for term infants).
indicating the positive course of the second phase of wound process-           Conclusion: The overall perinatal mortality was twice as high in the
wound healing was noted in 90,0±5,47% of healthy puerperas. The                Ukraine as in Denmark. The rates of antepartum deaths of non-
examination of lochia on the 5-6th day of puerperal period in puerperas        malformed, normal-weight fetuses were the same in the two countries,
with risk factors of development of puerperal purulent-septic                  which also indicate that these deaths are not related to social conditions
complications revealed that the inflammatory-regenerative type of              or health care.
cytogram was determined in 71,11±6,75% of women. In 28,88±6,75%                The biggest differences between the regions were found in the groups
of women the delay of regeneration beginning was observed                      considered potentially avoidable, and specific measures to improve
(characteristic inflammatory and degenerative-inflammatory type of             health care are suggested.
smear was noted).

FC1.27.08                                                                      ANALYSIS OF PERINATAL DEATHS (1991-1999) IN A TERTIARY
APPEARANCE OF OBSTETRIC PATHOLOGIES                                            A. Regi, P. Jasper, M. Mathai, A. Peedicayil, J. Lionel Christian
Z. Chiladze, V. Bakhutashvili, L. Gogiashvili, S. Rigvava, A. Chiladze,        Medical College Hospital, Vellore, India,
E. Khosiashvili, S. Zurabishvili, Georgian Obstetrics, Gynecology and
Reproduction Association, (GOGRA) Tbilisi, Georgia.                            Objectives: To analyze and compare the perinatal mortality rates (PMR)
                                                                               and causes of perinatal deaths during 1991-1995 and 1996-1999.
Uro-genital infection plays a significant role in the process of many          Study Methods: Data on perinatal deaths were obtained from labor
obstetric pathologies, including gestosis. Serologic investigations of         records and analyzed.
pregnant women were conducted alongside immunologic and                        Results: PMR in Booked patients were found to be 19.0 and 20.0 during
                                                                               1991-95 and 1996-99 respectively. In Unbooked patients the
68                                                                                                                       MONDAY, SEPTEMBER 4

corresponding figures were 106 and 112. The overall PMR were 41.8             FC1.28.05
(1991-95) and 43.8 (1996-99). The number of births increased after            PERINATAL MORTALITY IN UPPER EGYPT: RATIO AND RISK
1995; PMR which decreased in 1995, rose thereafter. Asphyxia was              FACTORS
found to be the leading cause of perinatal deaths followed by macerated       S.A. Abdullah, I.M. El-Nashar, Dept. OB/GYN, Assiut University,
stillbirths.                                                                  Assiut, Egypt.
Conclusion: PMR continues to rise in the developing countries.
Asphyxia remains the leading cause of perinatal mortality. Referral           Objectives: The aim of the study was to measure perinatal mortality ratio
pattern and birth weight distribution may explain this.                       in Assiut Governorate (Upper Egypt) and to investigate the causes of
                                                                              perinatal deaths and the associated risk factors.
                                                                              Study Methods: 7865 deliveries were included in this community-based
FC1.28.03                                                                     study. The study was conducted in Assiut city and three surrounding
MATERNAL AND INFANT MORTALITY REDUCTION (A NEW                                villages, using multiple sources and elaborate design.
APPROACH IN SLUMS OF GWALIOR M.P. INDIA)                                      Results: 465 perinatal deaths were identified. This gives a perinatal
M. Shrivastav, R. Shrivastav, Shrivastav Nursing Home, Gwalior, India         mortality ratio of 59.12 per 1000 births. Obstetric trauma was the most
                                                                              common cause of deaths in hospital deliveries (30%), followed by
Objective: The aim of the work is to educate and promote antenatal care       infections (25% of home deliveries), and congenital malformation
in slums of Gwalior, to reduce the maternal and infant mortality by           (9.3%). The PNMR was significantly higher in rural than urban
paramedics, supervised by medical graduates.                                  communities (66.7 and 53.5 per 1000 births, respectively), non educated
Study methods: A comprehensive antenatal care was taken of 1353               than educated mothers (67.8 and 37.4), low compared to high
women in slums of Gwalior for six years from Jan ’94 to Dec. ’99 by           socioeconomic status (64.4 and 33.1), no ante-natal care compared to
paramedics, supervised by medical graduates. The population of the            regular visits (69.5 and 39.8), hospital than home delivery (117.1 and
area was 26, 000. The cases were studied in the background of their           34.1), grandmultipara than low parity and elderly than young mothers.
socioeconomic status i.e. education, family size and income, along with       Conclusions: The present study revealed high perinatal mortality ratio in
age, parity, nature of delivery, birth weight, MMR-IMR and family             Upper Egypt. Analysis of the data showed that residence, education,
planning advice.                                                              socioeconomic status, age, parity, ante-natal care and place of delivery
Results: Incidence of PIH, only 3% had BP above 150/100, no case of           were significantly associated with increased risk of perinatal deaths.
eclampsia, average haemoglobin 9.7 gm%, no case of severe anaemia.
Of the total confinements 87.5% were normal, 6% were assisted or
forceps and only 6.5% were caeserean sections. There was only one             FC1.28.06
maternal death. The IMR was 45-50.                                            CAUSE-SPECIFIC MORTALITY AMONG NEWBORNS BELOW
Conclusion: The basic antenatal care taken by paramedics and                  1500 GRAMS IN ONE OF PERINATAL CENTERS IN THE CZECH
supervised by medical graduate alone would indirectly contribute to           REPUBLIC
attainment of the targets of reducing maternal and infant mortality.          P. Velebil, J. Feyereisl, Z. Stra_ák, A. M_churová, J. Melichar, J. Janota,
                                                                              Z. _tembera
                                                                              Institute for the Care of Mother and Child, Prague, Czech Republic
FC1.28.04                                                                     Dept. OB/GYN, Postgraduate Medical School, Prague, Czech Republic
GRAVIDITY WITH TWO TYPES OF DEATH (IUFD AND                                   Objectives: The aim of the study was to investigate the cause specific
NEONATAL DEATH)                                                               infant mortality among extremely low birth weight (ELBW) and very
S. Taavoni, Iran University of Medical Sciences, Tehran, Iran                 low birth weight (VLBW) infants.
                                                                              Study methods: Three hundred and fifty-eight inborn patients with
The field of perinatology emerged in response to research on the              birthweight under 1500 grams were included in this retrospective study.
treatment of the mother and fetus before and during childbirth, and           We divided our study group into two sub-groups according to their
infants particularly at risk during the neonatal period should be             birthweight: under 1000 grams (ELBW group; n=132) and 1000-1499
identified as early as possible in order to decrease Neonatal morbidity       grams (VLBW group; n=226). For database purposes and statistical
and mortality. This research is a correlation study with the goal of          analysis the Epi Info software package (CDC and WHO public domain)
identifying the correlation between: 1) the mother’s age and type of          was used.
death (IUFD and Neonatal Death) and 2) The gravidity and IUFD                 Results: Total mortality was 9.2 % (23.5 % in ELBW group; 0.9% in
Neonatal Death, calling in one of the hospitals of Iran University of         VLBW group). The main causes of death in ELBW group were (in order
Medical Sciences in 1997.                                                     of magnitude): sepsis/necrotising enterocolitis (48%, early to late onset
In this research 10,441 case notes were studied using poisson statistical     sepsis ratio 1:4), severe intraventricular hemorrhage grade III and IV
selection. After completion of the checklist, the results were displayed in   (23%), respiratory distress syndrome (16%) and other causes (13%),
12 tables. The descriptive and inferential statistics (X2, Tchouproff         while in the VLBW group were only two cases of death due to sepsis
coefficient) were used. The results show that total percentage of Death       (0.9%). While comparing two most frequent causes of death (sepsis,
(IUFD and Neonatal Death) was 2.29%. The highest rate that was seen           PVH-IVH grade III and IV) using 2x2 table analysis we found stronger
under 37 weeks (77.40%) and 39.75% of Death was in gravid 1 and               association of severe PVH-IVH with infant death (OR 2.63; 95% CI
33.05% of Death was in the 20-24 age group. There was a correlation           0.68, 9.83).
between the mother’s age and fetal life or Death (P<0.001) and between        Conclusions: According to frequency analysis only, sepsis is the leading
gravidity and fetal life or Death (P<0.001) and there was correlation         cause of death among ELBW newborns and severe PVH-IVH and RDS
between the mother’s age and IUFD or Neonatal Death (P<0.05). Other           follow. While looking for strength of association we found highest risk
remarkable points will be shown during the presentation of the study.         of death among ELBW newborns with PVH-IVH. The RDS, formerly
Although the IUFD and N.D. were higher in the 20-24 age group than in         reported leading cause of infant death, seems to move to lower order,
the other groups, this could perhaps be because most deliveries occurred      probably due to introduction of new therapeutic tools into clinical
in that age group. It seems that mothers under 37 weeks need more             perinatal practice.
health care, education and counseling. It would be better if research were
done to examine the correlation between the other characteristics and
IUFD or Neonatal Death with the goal of reducing these complications,
which is the ultimate goal of mother and child health care.
MONDAY, SEPTEMBER 4                                                                                                                                      69

FC1.28.07                                                                    audit and evaluate the procedure as a tool for quality improvement of
DIAGNOSTIC ACCURACY OF THE BIOHYSICAL PROFILE                                perinatal care.
SCORE IN PREDICTING ADVERSE PERINATAL OUTCOMES IN                            Study Methods: Perinatal deaths were identified in two hospitals and a
HYPERTENSIVE DISORDERS OF PREGNANCY                                          community based health area in the Omdurman region in 1999 giving an
G. Ivanovic, D. Ivanovic, P. Momcilov, O. Kontic-Vucinic, S. Kadija,         estimated perinatal mortality rate of 8 % . All cases were classified and
D. Plecas, M. Pervulov, Institute of OB/GYN, Clinical Center of Serbia,      categorized by the Nordic-Baltic perinatal death classification, and the
Belgrade, Yugoslavia.                                                        distribution was compared with that of Scandinavian and Eastern European
                                                                             countries, to identify categories that contributes most to the higher perinatal
Objectives: To estimate the accuracy and usefulness of the Biophysical       mortality rate of Sudan.
profile score (BPS) in predicting adverse perinatal outcomes in              Results: Intrapartum deaths of nonmalformed fetuses and neonatal death of
hypertensive disorders of pregnancy (gestational hypertension,               infants week 34 + were more than 10 times higher than in European
preeclampsia, chronic hypertension, superimposed preeclampsia).              countries. At a Danish-Sudanese workshop the results were discussed and a
Study Methods: One hundred and seventy-four fetuses jeopardized by           perinatal audit on specific Danish and Sudanese cases was introduced. The
maternal hypertension were monitored by BPS. Sensitivity (S),                experience and its impacts on perinatal care and future data collecting
specificity (Sp), positive predictive value (PPV), negative predictive       activities is presented.
value (NPV), efficacy (E) and ratio of LR+ to LR- (LR+/LR-) were             Conclusions: The application of a common classification of perinatal deaths
estimated for BPS £ 6/10 (positive test value). The adverse perinatal        may be a starting point for appropiate data collecting activities, perinatal
outcomes were: stillbirth, perinatal death (PD), 5 minute Apgar score        audit, and improvement of perinatal care in Sudan.
less than 7, need for NICU admission, premature birth (PB) and
intrauterine growth retardation (IUGR).
Results                                                                      FC1.29 ULTRASOUND IN GYNECOLOGY 2
 Outcome      S (%)   Sp (%)    PPV (%)     NPV (%)      E (%)    LR+/LR-
 Stillbirth    100     74.1       22.2        100        75.9        ¥       FC1.29.01
 PD            100     75.5       27.8        100        77.6        ¥       WHICH SONOGRAPHIC CRITERIA ARE IMPORTANT IN THE
 Apgar<7      60.3     91.3       79.5        80.5       80.2       16.1     DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME (PCOS) ?
 NICU         59.0     89.2       81.8        78.8       79.6       16.7     W. U. Atiomo, Dept. OB/GYN, Royal Devon and Exeter Hospital,
 adm.                                                                        Exeter, UK
 PB           55.0     89.2       75.0        77.1       76.5       10.1     A Prentice, Dept of Hematology, Derriford Hospital, Plymouth UK.
 IUGR         52.1     92.3       84.1        71.2       74.7       13.1
                                                                             P Dubbins, Dept. of Radiology, Derriford Hospital, Plymouth UK.
Conclusions: Ability of BPS to distinguish between “true” positive from
“true” negative results in prediction of perinatal mortality is excellent.   Objectives: The aim of this study was to determine the value of
                                                                             individual ultrasound features of polycystic ovaries in detecting PCOS
Low sensitivity of BPS in prediction of perinatal morbidity (probably
due to fetal adaptive responses to condition of chronic hypoxemia)           as not all women with polycystic ovaries on ultrasound will have the
                                                                             syndrome and clinical or biochemical features of PCOS may be present
reduces value of BPS as a screening test and LR+/LR- ratio. For this
reason we consider that BPS is not suitable as a single fetal surveillance   without ultrasound features
                                                                             Study methods: Thirty two women with PCOS and 40 controls were
test in pregnancies complicated by hypertensive disorders.
                                                                             prospectively recruited into the study. Interested participants were
                                                                             invited to the hospital for the diagnosis or exclusion of PCOS by history
FC1.28.08                                                                    and serum biochemical tests. Pelvic ultrasound scans were performed
                                                                             with the operator blind to the diagnosis. For this study, PCOS was
ENCIRCLEMENTS                                                                defined as a combination of a history of chronic oligo- or amenorrhoea
                                                                             and a raised free androgen index or a raised LH/FSH ratio in the absence
J. U. Pyrsikova, L. I. Titchenko, Moscow Regional Research Institute of
Obstetrics and Gynecology, Moscow, Russia                                    of diseases of the adrenals or pituitary such as congenital adrenal
                                                                             hyperplasia or hyper-prolactinaemia.
Objectives: The aim of this study was to determine the relationship          Results: The most sensitive ultrasound features were the presence of 10
                                                                             or more follicles (82% and 69% in the left and right ovary) and a
between hypocoiled umbilical cord and fetal outcome.
Study Methods: Fifty pregnant women were examined in third term. The         peripheral distribution of follicles (81.8% and 71.9% in the left and right
                                                                             ovary). Although ovarian enlargement and stromal brightness were not
umbilical coiling index (UCI) of each cord was calculated using
sonographia, by dividing number of helices by cord length from several       as sensitive as the previous criteria, stromal brightness was most
                                                                             specific. Combi ning all the criteria predicted a diagnosis of PCOS or
segments antenatally. Doppler flow velocities were obtained from
umbilical arteries and aorta in each fetus. The number of cord               control correctly in 86.4% of cases.
                                                                             Conclusion: This study shows that established sonographic criteria of
encirclements were noted. Fetal outcome was determined by using
Apgar scores after 5 minutes.                                                polycystic ovaries remain of value in the diagnosis of PCOS however
                                                                             the discrepancy between the left and right ovaries is an interesting but
Results: The umbilical coiling index in this group was 0.2±0.08
coils/cm(p<0.05). Systolo-dyastolic ratio in umbilical arteries and aorta    unexplained finding.
were increased in 68% of cases. Umbilical cord encirclements noted in
82% of cases, tight nuchal cord 34%, loose nuchal cord 66%, 61% of
fetuses had asphyxia, Apgar scores<7 had 24% fetuses, operative deliver
– 8 cases (16%), growth-restricted fetuses was determined in 12 cases        DECREASED UTERINE PERFUSION IN POLYCYSTIC OVARY
                                                                             SYNDROME: IS IT ALWAYS PRESENT ?
(24%) and one fetus (2%) died during early postnatal period.
Conclusions: Hypocoiled umbilical cord may be a marker for nuchal            Ajossa S, Guerriero S, Paoletti AM, Floris S, Mannias M, Manno S, Lai
                                                                             MP, Melis GB, Department of Obstetrics and Gynecology- University of
cord and bad outcomes of deliveries.
                                                                             Cagliari- Italy

FC1.28.09                                                                    Controversial results have been obtained evaluating uterine perfusion in
                                                                             patients affected by Polycystic ovary syndrome (PCOS)and this could be
S. Elamin*, J. Langhoff-Roos*, B. Bødker*, S. Larsen*, S.A. Ibrahim**,       due to the differences in subgroups of PCOS-patients considered in the
                                                                             studies. The aims of this study were to verify whether it is possible to
A.L. Ashmeig**, G. Lindmark***.
*Dept. Obstetrics, Rigshospitalet, University of Copenhagen, Denmark.        identify a subgroups of PCOS-patients with pathologic value of
                                                                             Pulsatility Index (PI)of uterine artery and to find factors affecting PI in
**University of Khartoum, Sudan. *** Dept Women’s and Children’s
Health, Uppsala University, Sweden.                                          PCOS-patients.
                                                                             Prospectively, 88 patients affected by PCOS were enrolled in the study
Objectives: To classify the perinatal deaths in Omdurman region, Sudan,      and underwent transvaginal ultrasonography associated with color
                                                                             Doppler evaluation of uterine artery, serum hormone determination and
compare with perinatal deaths in European countries, perform perinatal
                                                                             Body Mass Index (BMI) analysis during early follicular phase. The PI
                                                                             values were considered pathologic when they were > 3 in according to
70                                                                                                                      MONDAY, SEPTEMBER 4

previous studies. A control group of 15 patients were submitted to same      only the volume of visible tissue of the ovary without the pathologic
evaluations.                                                                 lesion (before op. 8.11 ccm and after op. 6.33 ccm).
The mean PI of uterine artery of PCOS-patients was significantly higher      Conclusion: This new method precisely determines the preserved tissue
than that of control group and the rate of pathologic values of uterine      of the ovary, thus favoring preservation of ovary by removal of mature
artery PI was significantly higher in PCOS-group, but the range of value     ovarian teratoma instead of ovaryectomy. This method makes possible
of PI was very high (1.57-7.25). The plasma levels of DHEAS and the          for better orientation for the site of preserved tissue of the ovary. The
mean BMI were significantly higher in the PCOS patients with                 follow-up on changes of the ovary volume may point out new lesions of
pathologic values of PI than in PCOS patients with normal values.            ovary following operation.
This study confirms that PCOS patients have higher resistance in uterine
arteries, however the results of this study also demonstrates that PCOS
itself does not predetermine a single uterine blood flow pattern. Higher     FC1.29.05
BMI and DHEAS seem to be the factors affecting uterine perfusion in          A TRANSVAGINAL COLOR DOPPLER STUDY OF UTERINE
this patients.                                                               BLOOD FLOW IN PRIMARY DYSMENORRHEA
                                                                             R. Dmitrovic, Dept. OB/GYN, General Hospital, Nova Gradiska,
OVARIAN VOLUME DECREASE WITH AGING IN PRE AND                                Objectives: The pain in primary dysmenorrhea is caused by excessive
PERIMENOPAUSE WOMEN                                                          prostaglandin production that causes vasoconstriction of the uterine
K. Oppermann-Lisbôna, S. Costa Fuchs, P.M. Spritzer, Faculdade de            small vessels and uterine ischaemia before the bleeding occurs. The aim
Medicina da Universidade de Passo Fundo, Passo fundo, RS, Brasil.            of the study was to determine if vasoconstriction of the uterine vessels in
                                                                             patients with primary dysmenorrhea is detectable by transvaginal color
Objectives: The aim of the study was to verify the size of the ovaries in    Doppler (TVCD) ultrasound. In addition, we wanted to investigate if
pre and perimenopausal women in a population-based sample. To                TVCD can be used as a diagnostic tool in this disease.
investigate the association of the variables, age, BMI, FSH, LH,             Study Methods: One hundred and four women suffering from primary
estradiol with ovarian volume.                                               dysmenorrhea (divided into mild and severe dysmenorrhea subgroup)
Study Methods: The study was cross-sectional with 303 women aged 35          and fifty healthy controls were included in this prospective study.
to 55 who had menstruated at least once in the past twelve months,           Women were examined with TVCD on first day of the cycle, once in the
selected randomly in the city of Passo Fundo, Brazil, between July 1995      folicular and once in the luteal phase. Measurements of resistance and
and February 1997. The excluded criterion was bilateral ophorectomies.       pulsatility index in uterine, arcuate, radial and spiral arteries were
The women were selected by conglomerated random process, and also            performed.
according to demographic sector as defined by the Brazilian Institute of     Results: 42% of women had severe dysmenorrhea and significantly
Geography and Statistics (IBGE, 1996). The study group consisted of          higher uterine blood flow indices than healthy controls in all three
women who were not using hormonal contraceptives or HRT, and who             measurements performed, on first day of the cycle in all vessels studied,
had the uterus intact. We included only one ovary (the largest) from each    in folicular phase in radial and spiral arteries and in luteal phase in
woman. Transvaginal ultrasonography was performed with Toshiba-              arcuate, radial and spiral arteries. 58% of women and mild
Tosbe using a 5,0 mHz transvaginal probe. Simple blood samples were          dysmenorrhea and significantly higher uterine blood flow indices than
taken once. Statistical analysis was conducted with use of software SPSS     healthy controls only on first day of the cycle and only in radial and
for Windows, release 6.0.                                                    spiral arteries.
Results: Ninety two women participated in this study. The average            Conclusions: We found that women with severe primary dysmenorrhea
ovarian volume of women between 35 and 55 years was 6.9 ± 3.8 cm3,           have elevated Doppler indices (suggesting abnormal blood flow) in
this being significantly larger in the periovulatory cycle phase (p<0,05).   uterine arteries throughout the whole cycle, and women with mild
The ovarian volumes in the age groups 40-44, 45-49 and 50-55 were            primary dysmenorrhea only when the bleeding starts and only in
smaller than the age group 35-39 (p<0,05). There was an association          smallest uterine arteries. Therefore, TVCD ultrasound as a simple,
with ovarian volume and age (p=0,03), and FSH (p=0,02); there was no         painless and noninvasive procedure could have a significant role in
association of ovarian volume with estradiol and BMI.                        diagnosing the severe cases of primary dysmenorrhea.
Conclusions: The ovarian volume decreases after the age of forty. To pre
and perimenopausal women the ovarian volume depends of the age and
the FSH levels; and not on BMI and estradiol levels.                         FC1.29.06
                                                                             HEMODYNAMIC CHANGES IN UTERINE ARTERIES IN
FC1.29.04                                                                    Tajfl P., Jurisic A., Antic N., Srbinovic P., Jankovic S., Maglic R.
THE MEASURING OF PRESERVED OVARY TISSUE VOLUME IN                            Narodni Front OB/GYN University Clinic, Belgrade, Yugoslavia.
YOUNG PATIENTS                                                               Aim: To analyze changes of vascular resistance in uterine arteries in
D. Jovic, R. Ganovic, N. Antic, E. Garalejic, M. Vasiljevic, R. Maglic,      postmenopause and to investigate correlation of resistance indices with
Dept. OB/GYN, University Hospital, Beograd, Yugoslavia.                      patients' age.
                                                                             Material and methods: In our study 49 women in postmenopause were
Objectives: The aim of the study was to mark and measure the volume          included. Transvaginal ultrasonography exams were performed in all
of preserved ovary tissue and investigate its importance.                    patients with 5 MHz color Doppler probe. Uterine flow velocity
Study Methods: We determined the volume of preserved ovary tissue in         waveforms were analyzed, and pulsatility (PI) and resistance index (RI),
three cases with mature ovarian teratoma. We used the transvaginal           peak systolic (Vmax), mean (Vmean) and end diastolic (Vmin)
ultrasonography (au5- Harmonic esaote biomedica, 5 mhz) using                velocities were measured.
“volume by track” measurement for areas of interest.                         Results: Median value of menopause was 5 years. There is no significant
Results: In two cases we measured the whole ovary, including the tumor,      difference between measured parameters in right and left uterine artery
and the volume of the tumor only, achieving the volume of the tumor          (ANOVA p>.05). Values of PI significantly correlated with age of our
only, achieving the volume of preserved ovary tissue by subtracting          patients (r=.404, p<.001). RI did not show significant correlation with
these two. It was possible to make measurements in the ovary with            patients' age. Values of Vmax, Vmean and Vmin showed significant
small tumor (1.5 cm and 4 cm separately). This way enables the               correlation with age (r=.557, r=.339, r=.349 respectively, p<.001).
inclusion of capsule and small almost invisible tissue of the ovary. The     Values of PI, Vmax, Vmean and Vmin showed significant correlation
volume of preserved ovary tissue measured using “volume by track”            with endometrial thickness in our study group (r=.228, r=.443, r=.30,
measurement, was almost the same before, and 30 days after the removal       r=.38 respectively, p<.01).
of tumor in these two cases (case 1 before op. 6.49 ccm and after op.        Conclusion: Significant increase of vascular resistance in uterine artery
8.08 ccm; case 2 before op. 28.8 ccm and after op 26.69 ccm). In the         occurs in postmenopause. In our study group PI, Vmax, Vmean and
third case we did not measure the volume in the same manner, because         Vmin had significant negative correlation with patients' age. These data
the teratoma was multilocular and big (10 cm), therefore we measured         confirm changes of distensibility of uterine artery wall in
MONDAY, SEPTEMBER 4                                                                                                                                    71

FC1.29.07                                                                     response in 54.5%. SR was 14/22 (63.6%), half of them had residual
INTRAOPERATIVE ASSESSMENT OF ADNEXAL MASSES BY                                disease after surgery. Survival Rate at one year was 20/22 (91%). In 22
LAPAROSCOPIC SONOGRAPHY                                                       months follow-up five patients died 1/17 from responders, and 4/5 from
P. De Jaco, F. Rosati, S. Gabrielli, T. Ghi, M. Ceccarini, M. Lima*,          nonresponders. By ultrasound, uterine cervix volume was significantly
L. Bovicelli, S.Orsola-Malpighi, via Massarenti, 13, Bologna, Italy,          smaller after therapy in responders (p<0,001). The tumor shrinkage after
40100.                                                                        chemotherapy in responders was 74%, and only 22,4% in non-
                                                                              responders (p=0,031). OR was a strong prognostic factor predicting
Objectives: Pre-operative evaluation of adnexal masses of different           mortality.
nature (neoplastic, flogistic, endometriosic, functional or paraovaric
cysts), performed by transvaginal sonography was compared to intra-
operative assessment performed by laparoscopic sonography. Direct             FC1.30 UTERINE CANCER
positioning of the probe on a laparoscopically detected lesion enables
echo-endoscopy to achieve a higher resolution of the images, since no         FC1.30.01
tissue at different acoustic impedance interposes between the probe and       THE USE OF ENDOCERVICAL CURETAGE IN THE
the organ considered. Topography of the lesion and its extension either       PREOPERATIVE ASSESSMENT OF CERVICAL INVOLVEMENT
to ovary as to surrounding tissues may be clearly detected (1).               IN ENDOMETRIAL CARCINOMA: A COMPARISON BETWEEN
Material and methods: Eight patients (mean age 32.4 years) admitted to        FRACTIONAL CURETAGE AND OFFICE ENDOCERVICAL
our Unit between February and July 1999 with a diagnosis of adnexal           CURETAGE
mass were considered in this study. Each patient pre-operatively              J. Toral, Dept. OB/GYN, Philippine General Hospital, Manila,
underwent transvaginal sonography (real time machines with 6.5 MHz            Philippines.
vaginal probes, color and power flow Doppler capabilities).
Subsequently laparoscopy with intra-operative scanning of the lesion          Objective: To compare the accuracy between endocervical curettage
was undertaken. Intra-operative scanning was performed by a side-firing       (ECC) as part of fractional curettage and endocervical curettage done as
sonographic machine, with a 10 mm diameter and 60 cm probe shaft              an office procedure in determining cervical involvement in endometrial
with a bending waist enabling motion through an arc of 45 degrees, at         carcinoma.
frequencies ranging from 5 to 7.5 MHz (Storz). Both pre-operative and         Study Methods: A validation study was done which included all patients
laparoscopic sonographic assessment of adnexal masses were based on           who had both a hysterectomy for endometrial carcinoma and a
scoring criteria from Sassone et al. (2) (internal structure, thickening of   preoperative fractional curettage or endometrial biopsy plus office ECC
the wall, septa, echogenicity of content).                                    at the Philippine General Hospital for a five-year period. The ECC slides
Results: In four cases out of eight (50%) pre-operative diagnosis has         were reviewed by one pathologist. The ECC outcomes were compared
been confirmed by laparoscopic sonography. In the other four cases pre-       with the hysterectomy specimen with regards to cervical involvement.
operative sonographic score has been modified after laparoscopic              The sensitivity, specificity, predictive values, and likelihood ratios of
assessment. In three of these cases score has been increased due to intra-    each were determined.
operative detection of less than 3 mm intracystic septa, that had been        Results: 77 patients were included: 52 had fractional curettage and 25
missed during pre-operative evaluation. In one case Sassone's score was       had office ECC after a positive endometrial biopsy. Among the 52
decreased since the adnexal mass after intraoperative scanning turned         patients, cervical involvement was correctly diagnosed in one out of six
out in hydrosalpinx. In seven cases out of eight, with both pre- and intra-   cases. Among the 25 patients, five out of ten were diagnosed correctly
operative scores < 9, pathologic report confirmed a benign ovarian cyst.      for cervical involvement. Office ECC had a higher sensitivity (50 vs.
In one patient, who had previously undergone right ovaro-salpingectomy        16.7), specificity (100 vs. 95.6), positive predictive value (100 vs. 33.3),
for borderline serous-papilliferous cystadenoma, a left adnexal mass          and likelihood ratio (15 vs. 3.83).
with a score of 12 was pre-operatively detected by transvaginal               Conclusion: The results suggest that office ECC may be valuable in
sonography, and intra-operatively confirmed by laparoscopic                   assessing cervical involvement in endometrial carcinoma. It may provide
assessment. In such a patient, however, laparoscopic sonography               a more sensitive and specific alternative to the traditional fractional
enabled a more detailed description of lesion's depth, advising the           curettage. This remains vital in localities where grade 1 or 2 Stage II
operator to perform a total ovariectomy.                                      carcinoma may be treated with radical hysterectomy due to limited
Conclusions: Albeit the small size of our study, preliminary results of       radiation facilities.
laparoscopic sonography look encouraging and suggest for this
technique a wider application in the next future. Particularly echo-
endoscopy is supposed to play a crucial role in those cases for which         FC1.30.02
pre-operative transvaginal sonography seems unable to provide a               ENDOMETRIAL BIOPSY USING A NOVAK’S CURETTE FOR THE
detailed description of the lesion.                                           DETECTION OF ENDOMETRIAL PATHOLOGY
References :                                                                  A. Habana, Dept. OB/GYN, University of the Philippines, Manila,
1-Yang W, Yuen P. Intraoperative laparoscopic sonography for                  Philippines, M. Calderon, Dept. OB/GYN, University of the Philippines,
improved preoperative sonographic characterization of adnexal masses.         Manila, Philippines, A. Manalo, Dept. OB/GYN, University of the
J Ultrasound Med 17: 53-61, 1998                                              Philippines, Manila, Philippines, Abelardo, Dept.PATH, University of
2- Sassone M, Timor-Tritsch E. Transvaginal sonographic                       the Philippines, Manila, Philippines, D. Silao, Dept. OB/GYN,
characterization of ovarian disease: evaluation of a new scoring system       University of the Philippines, Manila, Philippines, M. Festin Dept.
to predict ovarian malignancy. Ob Gyn 78: 70-76, 1991                         OB/GYN, University of the Philippines, Manila, Philippines

                                                                              Objectives: The aim of the study is to determine the adequacy and the
FC1.29.08                                                                     sensitivity, specificity, predictive values, accuracy and likelihood ratios
DOPPLER AND ECHOGRAPHIC EVALUATION OF UTERINE                                 of histology results obtained from endometrial biopsy with those
CERVIX CANCER MORPHOLOGIC PATTERNS BEFORE AND                                 obtained from curettage. Histology results will also be compared to
AFTER ADJUVANT CHEMOTHERAPY                                                   available hysterectomy specimens.
C.N. Resende, C.R. Miranda, M.S. Wanderley, A.C. Cunha, University            Study Methods: This is a prospective study where 431 consecutive
of Brasilia, SQN 206 Bloco A Ap 401, Brasilia, DF, Brasilia, Brazil,          patients with clinical indications for curettage were included. All
70844010.                                                                     participants underwent both an endometrial biopsy using the Novak’s
                                                                              curette followed by endometrial curettage. An experienced pathologist,
In order to assess response to three courses of neoadjuvant                   blinded to the method used, examined the specimens. The results were
chemotherapy (cisplatin 75 mg/m2 and ifosfamide 1 g/m2), we studied           also compared to that of the hysterectomy specimen in cases where a
22 patients with histologically proven uterine cervix carcinoma, FIGO II      hysterectomy was performed within 12 weeks from the procedure.
or III. We studied Objective Response (OR) and Surgical Ratio (SR)            Results: Significantly more inadequate specimens were obtained after a
compared to transvaginal ultrasound for tumor and cervix morphology,          biopsy than curettage. A comparison of both techniques based on the
before and after therapy. The mean age was 40 (29 to 57). By clinical         diagnosis of uterine malignancies showed a sensitivity of 83.3% and a
stage the OR was EC IIA 1/1, EC IIB 11/13 e EC IIIB5/8 (p=ns, Fisher´s        specificity of 100%. The accuracy was 99.7%. Based on the diagnosis of
test). OR was 77.3% (17/22), complete response 22.7% e partial                abnormal endometrium, a sensitivity of 37.8 %, specificity of 98.7% and
72                                                                                                                         MONDAY, SEPTEMBER 4

accuracy of 90.0% was seen. Likelihood ratios for a result that showed          FC1.30.05
abnormal endometrium increased the post-test probability more than 6            CLINICAL IMPACT OF PREOPERATIVE CONTRAST-ENHANCED
fold. There was a significantly greater inability to insert a curette for the   MR IMAGING IN PATIENTS WITH ENDOMETRIAL CARCINOMA
conventional curettage and likewise a greater need for cervical                 K A. Frei (1), H.M. Bond (2), Dept. OB/GYN, Frauenspital Fontana,
dilatation. One adverse event after the curettage was noted (0.2%).             Chur, Switzerland. K. Kin~kel, H. Hricak Dept. of Radiology,
Conclusion: Endometrial biopsy is a useful diagnostic procedure for the         University of California, San Francisco, CA, USA.
detection of endometrial cancer. It is highly accurate but must be used
with an understanding of its limitations.                                       Objectives: The histological grade of endometrial cancer is used to
                                                                                indicate the likelihood of deep myometrial invasion and to guide the
                                                                                decision for lymphadenectomy. The aim of this study was to assess the
FC1.30.03                                                                       frequency of deep myometrial invasion for each histological tumor grade
TREATMENT AND PROGNOSIS OF ADVANCED STAGE                                       and the potential impact of MRI on treatment stratification.
ENDOMETRIAL CARCINOMA                                                           Study Methods: Using a MEDLINE literature search and institutional
Lihui Wei, Jianliu WANG, Qi FU Department of Gynecology, People's               pathology reports, pre-test probabilities for deep myometrial invasion
Hospital, Beijing Medical University. Beijing 100044 Chian                      were correlated to tumor grade. Likelihood ratios for contrast-enhanced
                                                                                MRI were obtained through a meta-analysis using summary receiver
Objectives: To analyzed the prognostic factors of advanced endometrial          operator characteristics (SKOC). The incremental value of MM for the
carcinoma.                                                                      decision to perform lymphadenectomy was compared between grades.
Method: Analysed the clinic and pathological features of 39 cases               Results: Mean pre-test probabilities for deep myometrial invasion were
advanced endometrial carcinoma retrospectively.                                 derived from seven articles (1875 patients) and 125 institutional
Results: In 39 patients of endometrial carcinoma, adenocarcinoma were           pathology reports. Likelihood ratios for the prediction of myometrial
28 cases(71.7%), adeno-squmous carcinoma 5 cases(12.8%), serous                 invasion by contrast-enhanced MM were derived from nine studies (742
papillary carcinoma 5 cases(12.8%), clear cell cancer only one                  patients); positive and negative likelihood ratios were 10.11 and 0.1.
case(2.7%). And the grade 1,2 and 3 were 13, 12and 14 cases                     Mean weighted pre-test probabilities for deep myometrial invasion in
respectively. All patients were followed for 12 months to 102 months.           grade 1, 2 and 3 were 13%, 35% and 54%. Post-test probabilities for
The stage IIIa was 13 cases, recurred 3 cases, 2 of them died. The 5-year       deep myometrial invasion increased to 60%, 84% and 92% for a positive
survival rate was 65.6%. The stage IIIb 3 cases, one patient died of            and decreased to 1%, 5% and 10% for a negative MRI result.
recurence. The stage IIIc 12 cases, 8 of them died of recurrence and            Conclusions: Contrast-enhanced MRI significantly impacts the post-test
metastasis. The 5-year survival rate only was 14.5%. Stage IVb 11 cases,        probability for deep myometrial invasion in all grades endometrial
pelvic recurrence 3 cases, pulmonary matastasis 5 cases. 6 patients were        cancer and could assist in selecting patients requiring specialist referral.
died. The 3 year survival rate was 27.7%.
Conclusions: The prognosis of stage IIIc of endometrial carcinoma was
obvious worse than that of stage IIIa. Uterine serous coat involved,            FC1.30.06
lymphonode metastasis, multi-lesion out of uterine, and cancer cell             A MULTIVARIATE STUDY OF PROLIFERATIVE POTENCY OF
embolus of para-uterine blood vessuel and lymphotube were the                   ENDOMETRIAL CARCINOMA THROUGH EXPRESSION OF
important prognostic factors of advance endometrial carcinoma. The              EPIDERMAL GROWTH FACTOR RECEPTORS (EGFR), P53 GENE
recurrence of pelvic and peritoneal cavity and long distance matestasis         AND Bcl2 GENE
was much more in stage IVb .                                                    M.Abdel Hamid, M.Nasr El Dine, M.E.Azzam, R.Abdel Azim, Ain
                                                                                Shams University, 1 Nabil Abdel Rahman Street, 6th Zone, Nasr City,
                                                                                Cairo, Egypt.
VIABILITY AND ADHESION OF HYSTEROSCOPICALLY                                     Objective: To study the expression of EGFR, P53 gene, and the gene
DISSEMINATED ENDOMETRIAL CANCER CELLS IN VITRO.                                 regulating apoptosis (Bcl2) in correlation with clinical and
MG Arikan, U Weiss, O Reich, T Hahn1, H Pickel, K Tamussino, M                  histopathological subtypes, grade, and FIGO stage of endometrial
Cervar, G Desoye                                                                carcinoma, to select those patients who need more intensive treatment
Dept. OB/GYN, University of Graz, Auenbruggerplatz 14, 8036 Graz,               modalities.
Austria                                                                         Study Methods: Sixty five patients were included in this study, including
                                                                                39 cases of carcinoma, of various types, 6 cases of malignant mixed
Objectives: (i) To investigate the rate of dissemination of malignant cells     Mullerian tumour, 10 cases of hyperplasia and 10 cases of normal
into the peritoneal cavity by diagnostic fluid hysteroscopy and (ii) to         endometrium. EGFR, P53, and Bcl2 gene were detected
assess the viability and the adhesion ability of malignant cells, using an      immunohistochemically on paraffin embedded sections. A correlation
in vitro model.                                                                 was done between the staining pattern of the tumour and histologic
Methods: This paper presents the data on patients with FIGO stage I or          grade, stage and clinical outcome.
II adenocarcinoma of endometrium with residual tumor surface > 1cm in           Results: EGFR expression was noticed in 92%, P53 in 62% of
diameter at the time of hysterectomy. An in vitro hysteroscopy                  endometrial carcinomas and found to correlate with advanced stage and
mimicking a diagnostic hysteroscopy was performed after the total               unfavorable clinical outcome P<0.001. This was irrespective of tumour
abdominal hysterectomy and bilateral salphingo-ooferectomy. The                 type or grade. Uniform negativity of EGFR and P53 was noticed in
transtubally disseminated fluid was collected. Debris, erythrocytes and         normal and hyperplastic endometrium. An inversely proportional
most macrophages were removed by a modified Percoll gradient                    relation was found between P53 and Bcl2 expression. The latter was
separation. 5 X105 viable cells (trypan blue 0.05% dye exclusion) were          expressed in normal hyperplastic endometrium, and early stages of
incubated for 24 hours under standard conditions in 2 cm2 PVC                   endometrial carcinoma (36%), and those cases with favorable prognosis.
chambers. Culture medium (1 ml) consisted equal parts of DMEM and               Conclusions: These data highlights the importance of
Ham’s F-12 without FCS. Only the adherent cells were used for final             immunohistochemical detection of previous growth factors and
cytological studies. Outcome criteria were positive cytology (i) in             oncogenes besides other established parameters, to assess the prognostic
transtubally disseminated fluid and (ii) after 24 hours incubation.             outcome, to identify patients with poor short-term prognosis, who need
Results: In 14 (61%) specimens of 23 specimen which were eligible,              more effective anti-tumour modalities.
there was transtubal fluid dissemination. In 12 (52%) malign cells were
found in transtubally disseminated fluid. In 8 experiments (35%) the
malignant cells were identified to be adherent and viable after 24 hours
Conclusions: Fluid hysteroscopy which is used visualisation of
endometrium for better biopsy of cancer suspected areas may cause
dissemination of malignant cells into peritoneal cavity and in a
considerable part of the patients the disseminated malignant cells may be
viable and have potential of adherence out of tumor site.
MONDAY, SEPTEMBER 4                                                                                                                                  73

FC1.30.07                                                                    FC1.30.09
G. Galazios (1), A Giatromanolaki (2), E. Sivridis (2), V. Liberis (1), P.   BIOPSY
Tsikouras (1), P. Anastasiadis (1), Democritus University of Thrace,         A. Feridun, Y. Tolga, Dept. OB/GYN, Istanbul University Cerrahpasa
Alexandroupolis, Greece                                                      School of Medicine, Istanbul, Turkey.
(1) Dept. OB/GYN
(2) Dept. Pathology                                                          Endometrial cancers can often be diagnosed at an early stage because
                                                                             vaginal bleeding is an early symptom of these malignancies. But as
The prognostic significance of three recently emerged parameters,            usual there are cases where the diagnosis can be late due to the later
namely intratumoral angiogenesis and the anti-apoptic proteind bcl-2         presentation of this symptom. Therefore it would be favorable to have a
and mutant p53 was investigated in a series of 124 patients with             screening method whereby the clinician can diagnose the early stage
endometrial adenocarcinomas of the endometroid cell type. All patients       disease or even the premalignant lesions in the asymptomatic subgroup
were treated with total abdominal hysterectomy and bilateral                 of patients. In order to achieve this objective vaginal ultrasonography
oophorectomy, without node dissection. When deep myometrial                  and serum CA 125 levels were evaluated in asymptomatic
invasion or advanced stage of disease was confirmed, adjuvant                postmenopausal women who had been deemed normal via history and
radiotherapy was given. Intratumoral angiogenesis was assessed in tissue     gynecologic examination. Endometrial pipelle biopsy was performed to
samples, after immunohistochemical staining with the anti-CD31               those who had an endometrial thickness of 3 millimeters or a CA 125
monoclonal antibody. The mean microvessel density (MVD) was 23.2 ±           lever higher than 35 U/mL. From the 352 patients screened this way 106
14.1 (range 4-60;95% CI 20-25.8). Microvessel density was high (>30)         of them had an endometrial thickness more than 3 millimeters. All of the
in 30% of endometrial adenocarcinomas, medium (15-30) in 33% of the          CA 125 levels were under the preset level of 35 U/mL. Of the 106 cases
tumors and low (<15) in the remaining cases (37%). A strong                  to whom a pipelle biopsy was performed 30 of them had an
sytoplasmic and/or perinuclear expression of bcl-2 in more than 10% of       endometrium with estrogen effect, 19 had simple hyperplasia, 1 had
the neoplastic cells was considered as being positive, and noted in 35.5%    complex hyperplasia and 1 had atypical adenomatous hyperplasia. It has
of the endometrial neoplasms; it was more frequent in the less               been concluded that the sensitivity of the test could be improved by
vascularized carcinomas (p=0.03). Nuclear p53 accumulation in an equal       performing enndometrial biopsies at endometrial thickness of more than
percentage of neoplastic cells (10%) was less common (7.2%). In              5 mm instead of the 3 mm. The CA125 levels were of no use in the
univariate analysis, early stage of disease, absence of lymphatic-vascular   protocol due to the fact that none of the patients had a value higher than
space invasion (LVI) and low intratumoral MVD were the parameters            the preset limit of 35 U/mL. It has been concluded that routine
associated with an improved survival (p=0.0001, p=0.001 and p=0.009,         application of the protocol would be beneficial for the diagnosis of
respectively). In multivariate analysis however the only independent         malignant and premalignant lesions of the endometrium.
variable noted was stage disease (p<0.0001). Within sate I endometrial
adenocarcinomas, only intratumoral angiogenesis was associated with
prognosis (univariate analysis): high MVD cases had a significantly
worse prognosis compared to medium MVD (p=0.02). Low MVD
adenocarcinomas, on the other hand, were associated with and
intermediate prognosis, indicating that other factors, such as hypoxia and
related mechanisms, may also be important. It is suggested that
intratumoral angiogenesis may prove useful in selecting a subgroup of
cancer patients, among others with stage I endometrial disease, that
would benefit from additional treatment.

M. Ursic-Vrscaj, S. Bebar, P-A. Fras, A. Djurisic, Institute of Oncology,
Ljubljana, Slovenia.

Objectives: The aim of the present retrospective study was to evaluate
the relationship between he use of tamoxifen (TAM) and development
of endometrial carcinoma (EC).
Study Methods: This retrospective study included 408 patients (pts),
aged 55 years or more, treated for invasive breast cancer (285 pts were
treated with TAM, 123 pts without it) from 1988 to 1992. The pts who
had hysterectomy were not included. The observation period was 5 to 9
years. Mantel-H test and Fisher’s test were used.
Results: As to the most risk factors of EC, no statistically significant
difference was observed. The daily dose of TAM was 20mg. The median
treatment period was 38 months (1-97). In 15% of pts, TAM-related side
effects were noted 30 months later; the most common were uterine
bleeding. EC was detected in 10/30 pts with curettage, while others ahd
polipous changes and cystic hyperplasia. In the group of pts without
TAM, curettage was performed in 4 pts. In view of curettage, the
difference between the two groups was statistically significant
(p=0.0014). In the group of pts without TAM, EC was detected in 2 pts.
Evaluated RR was 2.16 (0.48-9.70).
Conclusions: The treatment with TAM increases the risk of benign
endometrial changes and of EC. Pts using TAM should know what
symptoms and signs be reported.
74                                                                                                                       MONDAY, SEPTEMBER 4

V1.01      VIDEO SESSION: TOPICS IN CESAREAN SECTION                         procedure. The lateral extension of the rectus sheath incision is
           AND ULTRASOUND                                                    performed manually even when previous cesarean scars are present and
                                                                             no dissection of the space between the uterine peritoneum and
V1.01.01                                                                     myometrium is made. Manual removal of the placenta is not performed
CESAREAN SECTION USING COHEN’S INCISION AND SINGLE                           routinely and the uterus is usually not brought out of the abdomen for
LAYER CLOSURE                                                                suturing. The subcutaneous tissue is closed when its depth exceeds 2 cm,
J.B. Sharma, M. Malhotra, R. Arora, Dept. OB/GYN, MAM College,               and subcuticular or separate stitches are used to close the skin.
New Delhi, India.                                                            Results: This technique has now been applied in over 350 cases in our
                                                                             Department, and was widely adopted mainly by the younger doctors. A
Objectives: The aim of the study was to evaluate the safety and              randomized clinical trial is under way to compare it with Kerr’ classical
operative results of cesarean section by modified technique.                 technique. The first 38 cases of the study assigned to the modified
Study Methods: One hundred and twelve women who successfully                 Misgav Ladach technique had a mean operating time of 21.3 minutes
underwent cesarean section for the first time by the modified technique      (min. 14, max. 30), 83% of the women had bowel emptying by the 2nd
were included in this prospective study in which abdomen was opened          post-operative day, there were two minor scar complications, one lower
by a transverse Cohen’s incision and uterus was closed in one layer with     urinary tract infection and one of post-operative hemorrhage.
vicryl suture and either peritoneum was not closed. Rectus sheath and        Conclusions: We believe that these modifications, while maintaining the
skin were closed with number one vicryl.                                     main principles and advantages of the Misgav Ladach technique, have
Results: Cesarean section was done for various obstetric indications (82     made it more acceptable to the doctors in our Department. Furthermore,
emergency cesareans, 30 elective cesareans). Mean time taken was 16          the maintenance of the Pfannenstiel skin incision is greatly preferred by
minutes, mean blood loss was 320 ml. Mean day of mobility, starting          our pregnant women.
normal diet and discharge from hospital were 1.2 days, 2.1 days, and 4.1
days respectively. Blood transfusion was required in 18 (16.07%) cases.
Post-operative complications were fever in 13 (10.71%) cases, paralytic      V1.01.04
ileus in 8 (7.14%) cases, urinary tract infection in 11 (9.28%) cases,       CESAREAN SECTION PLUS SPLENECTOMY IN THE SAME
wound hematoma in 2 (1.78%) cases which did not require repeat               SURGICAL TIME, A RARE CASE OF SPLENOMEGALY
laparotomy, wound sepsis in 9 (8.03%) cases and gaping in 3 (2.67%)          COMPLICATING THE PREGNANCY
cases requiring restitching in 2 cases. There was no maternal mortality      DK. Ennes, A.P.T. Lisboa, CA. Andrade, A. do Monte, Y. Monzani,
or major morbidity in any case.                                              S.R. Fernandes, J.A.V. Mamede, L. Jr. Kulay, M.B. Reis, O. Trama.
Conclusions: Cesarean section performed by modified technique is safe,       Dept. OB/GYN, Dept. of General Surgery, University of Mogi das
fast and effective.                                                          Cruzes, Sao Paulo, Brazil.

                                                                             Objectives: Our objective is to present a case of accentuated
V1.01.02                                                                     splenomegaly and pregnancy, when occurring obstetric indication to
UTERINE ARTERY LIGATIONS DURING CESAREAN SECTION                             cesarean section, splenectomy in the same surgical time, was performed.
D.K. Dutta, B. Dutta, Dept. OB/GYN, Naihati State General Hospital,          Study Methods: The authors report a case of a 19-year-old patient, first
Kalyani, West Bengal, India.                                                 pregnancy, being watched since the third month of pregnancy in prenatal
                                                                             care and serial ultra-sound, evaluating the pregnancy and the splenic
Objectives: The aim of the study is to investigate the effect of uterine     enlarging. Around the 37 week, the patient was interned with abdominal
artery ligations during cesarean section, on maternal mortality and          pain in the left hypochondrium and mesogastrium, by splenic
morbidity, subsequent menstrual flow and future fertility.                   compression. Three days later, the patient went into labor and with
Study Methods: 98 women had undergone bilateral uterine artery               obstetric indication of cesarean section due functional dystocia
ligations during cesarean section from Jan. 1993 to Dec. 1997. 35.7%         associated to the breech presentation in primigravida it was decided to
cases had a major degree placenta previa, 61.2% cases had tear or            practice splenectomy in the same surgical time.
laceration of lower segment of uterus and 3.1% had placenta accreta.         Results: The cesarean section was done under peridural anesthesia with
Results: Out of ninety-eight cases, 96.9% had shown good effectiveness       catheter through left paramedian incision. During the splenectomy time,
to control bleeding, 1.1% cases had broad ligament hematoma which            it was firstly chosen the artery ligature with temporary preservation of
managed successfully. 2.1% cases had undergone cesarean hysterectomy         the splenic vein, to proceed the self transfusion and reduce the spleen
(sub-total) due to failure to control bleeding in case of major degree       size, facilitating its remission and getting better the patient’s
placenta previa. Maternal mortality was nil, but in 2.1% cases, maternal     hematological levels that in the intra-operative presented 6.0 g/dl of
morbidity was observed. During follow-up study up to 2 years with            hemoglobin rate and in the immediate Postoperative, 8.0 g/dl avoiding
ninety-six patients, subsequent menstrual flow and future fertility were     therefore blood transfusion.
found to be unaffected in 97.9% and 25.5% cases respectively.                Conclusions: The spleen was submitted to histopathologic study
Conclusion: Bilateral uterine artery ligations during cesarean section       revealing sclerocongestive splenomegaly and multiple focus of ischemic
was found to have significant effect in controlling bleeding, thereby        infraction. The patient and the newborn leaving the hospital on the
reducing maternal mortality and morbidity. This method is simple, safe,      seventh day after the surgery. Thus we could show that in the association
quick, easy to perform, less complicated and also permits time for           of medical and surgical complications and pregnancy, it is possible to
further steps. Subsequent menstrual flow and future fertility were           use a more aggressive treatment without complications, assuring the
unaffected.                                                                  well being of the mother and the child.

V1.01.03                                                                     V1.01.05
SECTION                                                                      METHODS OF STUDY IN DIAGNOSIS OF GYNECOLOGICAL
D. Ayres-de-Campos, P. Xavier, A. Reynolds, B. Patricio                      DISEASES IN GIRLS AND GIRLS-TEENAGERS
Dep. Ginecologia e Obstetricia, Hospital S. João, Faculdade Medicina         V. Yatsenko, V. Chaika, L. Matitsina, Dept. PED/AD GYN, Donetsk
do Porto, Portugal                                                           regional center of Maternity and Child Protection, Donetsk, Ukraine.

Objective: To present a modified Misgav Ladach technique for cesarean        Objectives: Ultrasound investigation (USI) is one of the most
section.                                                                     informative methods in diagnosis of gynecological disease in girls and
Study Methods: Modifications to the Misgav Ladach technique were             girls-teenagers, particularly in urgent situations to carry out differential
developed, including the performance of a Pfannenstiel skin incision         diagnosis and o choose the future tactics of the patients’ maintenance.
with upward dissection of the subcutaneous tissue so as to reach the         Study Methods: We have examined 63 girls and girls-teenagers at the
rectus sheath above the insertion of the pyramidalis muscles. If this does   age of 13-18, whom under the control of USI rectoabdominal study,
not occur, a single cut with the scissors in the mid-line to separate the    treatment and diagnostic curettage of mucous cavity of the uterus and
pyramidalis from their rectus sheath insertion is usually sufficient to      vaginoscopy were carried out. The examination was carried twice:
create a sufficient large operating field for the remaining steps of the     without filling the urinary bladder in children’s gynecologic chair; with
MONDAY, SEPTEMBER 4                                                                                                                                  75

filling the urinary bladder in the position in children’s gynecologic chair.   V1.01.09
Vaginoscopy was carried out with children’s vaginal speculums # 1, 2.          PULSATILITY INDEX (PI) OF BOTH RAMI ASCEDENTES
Results: The first group was formed by 39 girls teenagers with cysts and       ARTERIAE UTERINAE IN ENDOMETRIAL CANCER
ovarian cystomas and tubo-ovaian growth of uterus appendages whom              G.J. Babusku (1), E. Babusku (2), E. Matevska (1)
under the control of USI rectoabdominal investigation was performed.           (1) Dept. OB/GYN, University Hospital, Skopje, Macedonia.
The second group was composed of 4 patients with Yu UB, under the              (2) Dept. of Radiology, Municipal Hospital, Skopje, Macedonia.
control of USI the treatment and diagnostic curettage of the mucous
cavity was carried out. The third group was composed by 5 girls-               Objectives: The aim of our analysis is to define the possibility of
teenagers with humenal atresia, mucocolpos and hematocolpos. The               endovaginal ultrasound’s diagnosis of endometrial neoplasia, to
fourth group was formed by 1 girl with adrenogenital syndrome of the           determine the mean value of pulsatility index r. ascendens a. uterinae.
IV degree virilisation of urogenital sinus, who menstruated through            Study Methods: We have included 40 patients in examination, either in
urogenital sinus. Th combined method of diagnosis helped the correct           the control group. First of all, we have examined them with endovaginal
establishment of the diagnosis and determination of future tactics of the      ultrasound pulsed color Doppler, measuring the P.I. of r. ascendens a.
operative treatment capacity of the vaginoplasty.                              uterinae, and then we have done explorative curettage.
Conclusions: Thus, we consider, that the combination of USI and other          Results: In the examination group the mean value of P.I. was 1.54 on left
methods of diagnosis increases informaty of the study and increases the        side and 2.86 in the control group. On the right side 1.50 in the
truth of the diagnosis.                                                        examination group and 2.84 in the control group.
                                                                               Conclusions: The different values of P.I. among analytic patients show
                                                                               that there is evidence specific of hemodinamics of uterinae arteries of
V1.01.07                                                                       endometrial neoplasia.
F. Tamási, S. Bagdány G. Szathmáry, Dept. OB/GYN, Csepeli Weiss
Manfred Hospital, Budapest, Hungary.

Objectives: The occlusion of the fallopian tube is the cause of sterility in
60 percent of the cases. With a diagnosis of the tubal occlusion, we
have only a few possibilities. These methods are the HSG, the
perflation, the chromopertubation and others. A new method was
developed 10 years ago named Hy-Co-Sy.
Study Methods: We started to use this method one year ago, and since
this time we have performed 26 Echovist-200 examinations.
Immediately after the bleeding the Hy-Co-Sy method is performed as an
ambulatory procedure. We have not had any complications with this
method so far.
Results: In 12 cases we detected a tubal occlusion with this method, and
in 60 percent the result was confirmed with chromopertubation as well.
All the examinations have been recorded on video tapes, and we have
also produced simple photos.
Conclusion: The Hy-Co-Sy is a good applicable method in the daily
practice. It is easy to perform because the length of the examination is
only 10-15 minutes. We can say that is does not have any
disadvantages. This method is not very expensive, however it is

G.J. Babusku (1), E. Matevska (1), E. Babusku (2)
(1) Dept. OB.GYN, University Hospital, Skopje, Macedonia.
(2) Dept. Radiology, Municipal Hospital, Skopje, Macedonia.

Objectives: In this abstract we want to define the mean value of RI of
both the rami ascendentes arteriae uterinae in endometrial cancer.
Study Methods: In 40 patients after explorative curettage and
histologically confirmed endometrial cancer, endovaginal ultrasound
was performed. This is the group that was analyzed v.v. control group
consisted of same number of patients.
Results: The mean value of RI of left r. ascendentes a. uterinae in the
examined group was 0.82 and the control group was 0.94 on the right
side in the examined group the mean value of the RI was 0.78 and 0.96
in the control group.
Conclusions: The estimated minimal value of RI of r. ascendentes of a.
uterinae on both sides in patients with endometrial cancer have
specifications. The measurements of RI with endovaginal ultrasound as
noninvasive applicative method represents a very useful tool for the
diagnosis of endometrial cancer.
76                                                                                                                                MONDAY, SEPTEMBER 4

POSTERS                                                                       Study Methods: The study groups consisted of 19 pregnant women with
                                                                              PE and 14 pregnant women with TH diagnosed between 30 – 37 week of
P1.01 ANTENATAL CARE AND DIAGNOSIS                                            gestation. Exclusion criteria were: uterine contractions, infection and
                                                                              therapy with steroids before blood sampling, renal diseases or chronic
P1.01.01                                                                      hypertension prior to pregnancy. PE and TH were defined according to
SCREENING FOR FETAL CHROMOSOMAL ABNORMALITIES                                 USA National Health Institute criteria. Peripheral blood was obtained by
USING MATERNAL SERUM TRIPLE MARKERS IN KOREAN                                 venipuncture. Standard immunoflorescent marking techniques for whole
WOMEN OF ADVANCED MATERNAL AGE                                                blood with one-step monoclonal antibodies were performed.
S. K. Kim, J.E. Chung, J.W. Kim, Dept. OB/GYN, Yonsei University              Lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, CD3-
College of Medicine, Seoul, South Korea                                       /CD16+/CD56+, CD3+/CD16+/CD56+, CD8+/CD28+,
                                                                              CD4+/CD45RA+, CD4+/CD45RO+, CD3+/CD69+) analysis was done
Objectives: To assess the value of maternal serum triple marker               with flow-cytometer FACSCalibur with 488nm argon laser, lymphocyte
screening with the alpha-fetoprotein (AFP), human chorionic                   cells region was chosen with LeucoGATE, analysis performed with
gonadotropin (hCG) and unconjugated estriol (uE3) in detecting fetal          SimulSET v.3.1 programme. For cytokine analysis peripheral blood
chromosomal abnormalities in Korean women of advanced maternal                lymphocytes (PBL) were cultured for 72 hours in standard 1640 RPMI
age.                                                                          medium enriched with 20% FCS, L-glutamine, antibiotics and mitogen
Study Methods: Maternal sera were collected from 310 women aged 35            (PHA). Cytokine levels (IL-2, IFN-gamma, TGF-beta) were estimated in
years and older between 15 and 20 gestational weeks before                    culture supernatants by using ELISA.
amniocentesis. Patient-specific second trimester risk for Down’s              Results: The differences in peripheral blood lyphocyte subset
syndrome was calculated using the maternal age and levels of triple           composition as well as cytokine production “in vitro” between PE and
marker screening.                                                             TH were insignificant.
Results: Seven fetal chromosomal abnormalities were identified                Conclusion: Despite different clinical appearance, PE and TH seem to
including three trisomy 21; one 46, XY/47, XY+21; one trisomy 13; and         have common pathogenesis. However, there is possibility that changes
two 45, X. A cutoff level of 1:100 detected 50% (2/4) of fetal Down’s         observed in peripheral blood are not significantly different in PE and TH
syndrome and 33.3% (1/3) of other chromosomal abnormalities with a            because of their low importance for immunopathogenesis.
15.8% false positive rate. Using a cutoff level of 1:200, the detection and
false positive rate for fetal Down’s syndrome was 100% and 28%
respectively.                                                                 P1.01.04
Conclusions: Second trimester maternal serum triple marker test is an         HELLP SYNDROME: THREE CASES ARE REPORTED
effective screening tool for detection of fetal Down’s syndrome but not       M.L. Fernandez-Perez, J. Lombardia, M.A. Garcia-Largo, M. Sanchez-
for other chromosomal abnormalities in Korean women of advanced               Dehesa, J. Porro, A. Sanchez-Dehesa, Dept. OB/GYN, Hospital Virgen
maternal age.                                                                 de la Salud, Toledo, Spain

                                                                              Hellp syndrome (hemolysis, elevated liver enzyme levels and low
P1.01.02                                                                      platelet count) is a rare complication of pregnancy that can be serious for
AN ADMISSION TEST FOR LOW RISK PREGNANCIES – A                                both the mother and the infant and occurs in 4 –1 2% of patients with
SOUTH INDIAN EXPERIENCE                                                       severe preeclampsia.
A.N. Kekre, L. Seshadri, Dept. OB/GYN, Christian Medical College              The Hellp syndrome usually arises antepartum; postpartum occurrence is
Hospital, Vellore, India.                                                     a rare and often related to preeclampsia antepartum or durante parto. We
                                                                              report three cases of Hellp syndrome, two antepartum and one 24 hours
Objective: To evaluate the usefulness of a “simple bell test” to identify     postpartum.
fetuses at risk in early labor.                                                          INITIAL DIAGNOSIS       RECOVERY PERIOD
Study Method: A prospective study of 300 low risk women in early
labor was undertaken. After admission a vibroacoustic stimulation was         Variable      No.1 No. 2 No. 3      No. 1          No. 2 No. 3
done using a simple office bell. Maternal perception of fetal kicking
                                                                              Hematocrito (%) 29.4   35   35.8        35.5        33.7   34.3
immediately after the test was considered as positive while in the
absence of fetal movement test was considered as negative. The results        Hemoglobin(g/dl) 9.5   12   11.9     11.7          11.3    11.3
of maternal perception of sound provoked fetal movements was
correlated with perinatal outcome using specificity, sensitivity, positive    Platelet count 63000 36000 23000   147000 296000 296000
predictive value, negative predictive value, likelihood ratio.                Prothrombin time 70 100 97       100   100 100
Results: Vibroacoustic stimulation test was positive in 65.3% of cases        (%)
and negative in 34.7%. The perinatal outcome correlated with
stimulation test. Maternal perception of sound provoked fetal movement        Cefalin time(sg) 37(28) 31(28) 34(27)     36(36) 27(30) 30(33)
had a sensitivity of 100%, specificity of 67.94%, positive predictive
value of 12.38%, negative predictive value of 100%, likelihood ratio          Fibrinogen(mg/ml) 395 305 580           566          668    598
3.12.                                                                         GOT (ASAT)
Conclusions: Maternal perception of sound provoked fetal movement is          (mU/l)      246 232 1124     21           36        40
a simple inexpensive screening test to identify fetuses at risk of hypoxia    GPT (ALAT)
especially in developing countries so that intrapartum fetal monitors can     (mU/l)        - 217 639    44           67         122
be used selectively for monitoring high risk pregnancy.
                                                                              LDH (mU.l)        995 1245 2560    555   641 819
                                                                              Total bilirrubin    2.3 1.9 1.4     0.6  0.4 0.4
P1.01.03                                                                      (mg/dl)
PREECLAMPSIA AND TRANSIENT HYPERTENSION OF                                    Serum creatinine
PREGNANCY: IS IT POSSIBLE TO DIFFERENTIATE BETWEEN                            (mg/dl)          - 0.8 0.7     0.9   0.8 0.8
J.R. Wilczynski, H. Tchórzewski, M. Banasik, E. Glowacka, K. Zeman,           Arterial pressure 160/11 175/11 160/10       130/75 110/70 100/70
A. Malinowski, A. Wieczorek, M. Szapakowski, M. Nowak, J.                                  0   0   4
Wilcyznski, G. Krasomski, P. Oszukowski, Polish Mother’s Memorial
Hospital Research Institute, Lodz, Poland                                     Urine proteins   +++ +++     ++     -          -     -
Objectives: The aim of this study was to check the hypothesis that
analysis of peripheral blood lymphocyte subsets as well as cytokine
profiles produced by them “in vitro” is a useful tool in differentiation
between PE and TH for confirmation of their distinct pathogenesis.
MONDAY, SEPTEMBER 4                                                                                                                               77

Conclusions: Treatment of Hellp syndrome is symtomatic with the             Subject: In this geographically based retrospective study in all fetuses
objective to stabilize the general condition of the mother, improved        from therapeutic abortions macro, and microscopical pathological
hemodynamic conditions and the impaired hemocoagulation. A very             examination was carried out, what was complemented in indicative
important therapeutic step is the early termination of pregnancy.           cases by immunohistochemistry, interphase cytogenetic examinations,
                                                                            flow cytometry, and X ray examinations. The findings were compared
                                                                            with the clinical observations, including results of ultrasonography and
P1.01.05                                                                    cytogenetic examinations.
ERYTHROPOIETIN IN THE TREATMENT OF ANEMIA IN                                Results: In the 121 therapeutic abortions the distribution of
OBSTETRICS                                                                  malformations were 45 central nervous system anomalies (37%), 12
E.Angelakis, S.Sifakis, E.Papadopoulou, E.Kolibianakis, G.Manidakis,        genitourinary anomalies (10%), 25 gastrointestinal anomalies (21%), 2
E.Vardaki, E.Koumantakis. Dept of Obstetrics and Gynaecology,               respiratory system anomalies (1,65%) 8 cardiac anomalies (6,6%) 4
University of Crete, Heraklion, Crete, Greece.                              teratomas (3,3%), 4 cases of parvovirus B19 infection (3,3,%) and 20
                                                                            other anomalies (16,5%) as revealed by autopsy. In 60% of the cases
Objectives: The purpose of this study was to investigate the role of        there were multiple malformations, while single anomalies comprised
recombinant human erythropoietin (rHEPO) in the treatment of                37% of the cases. No anomaly was seen in 3 % of therapeutic abortions.
moderate and severe anemia in pregnancy.                                    With the comparison of the pathological and clinical findings out of the
Study methods: Twenty-six women diagnosed with iron deficiency              121 therapeutic abortions in 90% the clinical diagnosis and indication of
anemia were studied (23 women during gestation and 3 during                 the therapeutic termination could be confirmed. In 4% the clinical
puerperium). All patients were admitted during the treatment period in      observation and diagnosis were modified without implication about the
the department of Obstetrics and Gynecology at the University Hospital      therapeutic termination of pregnancy. The clinical indication could not
of Heraklion, Crete. The treatment protocol included a combination          be supported in 3 % of the cases. On clinical examination the percentage
therapy of 150 IU / Kg / day rHEPO subcutaneously three times per           of cases with correctly designated and none missed anomalies amounted
week combined with 1600 mg / day of oral proteinsuccinylate iron for a      to 49%. However in 51% additional or different lethal, severe, or major
period of four weeks. The criteria in order to initiate the therapy were:   malformations were revealed or excluded by feto-pathological
hemoglobin level below 8.5 g / dl and evidence of iron deficiency           examinations.
anemia (reduced serum ferritin values and total iron binding capacity,      Conclusion: We stress the importance of pathologist’s collaboration with
abnormal morphological red cell indexes: MCV, MCH, MCHC).                   obstetricians, pediatricians, pediatric surgeons, neurosurgeons, cardiac
Results: 19 out of 26 women showed an immediate response, increasing        experts, radiologists and geneticans all of whom are involved in prenatal
hematocrite and hemoglobin to normal levels during the first two weeks      and postnatal care.
of treatment. In five women there was no improvement in the
hematological parameters while in two women deterioration occurred,
resulting in blood transfusion.                                             P1.01.08
Conclusions: This combined treatment with rHEPO and oral                    MATERNAL SERUM LEVELS OF ALPHAFETOPROTEIN, BETA
proteinsuccinylate iron may serve as an alternative to blood transfusion    SUBUNIT OF HUMAN CHORIONIC GONADOTROPIN AND
in anemic patients who are resistant to iron treatment alone. Poor          UNCONJUGATED ESTRIOL IN NORMAL PREGNANT WOMEN
response to the treatment with rHEPO may be due to insufficient iron        BETWEEN 14 AND 19 WEEKS OF PREGNANCY IN RIBEIRAO
supplementation or absorption during the treatment period or be due to      PRETO-BRAZIL.
factors that inhibit erythropoiesis during pregnancy such as undetected     M.C. Patta, G. Duarte, J.M. Pina Neto, J.C. Machado, S.P. Cunha, A.T.
infections.                                                                 Berezowski. Department of Gynecology and Obstetrics, Faculty of
                                                                            Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao
                                                                            Paulo, Brazil.
FETAL LIMB ANOMALIES : PREVALENCE AND SIGNIFICANCE                          Objectives: To determine maternal serum (MS) levels of
R Lavanya , MS Urala, Dept.OB/GYN, KMC Hospital, Manipal,                   alphafetoprotein (AFP), b-subunit of human chorionic gonadotropin
Karnataka, India, 576119                                                    (bhCG), and unconjugated estriol (uE3) in normal pregnant women
                                                                            between the 14th and 19th week of pregnancy. The values obtained were
Objectives: To study the prevalence and outcome of fetuses with limb        adjusted to the maternal weight and their color skin.
anomalies                                                                   Study Methods
Study Methods: During the study period of five years (1995-1999), all       In a cross sectional way were selected 238 pregnant women between the
fetuses delivered / aborted in the second trimester were studied for        14th and 19th week of pregnancy. Gestational age was determined based
congenital anomalies. Detailed evaluation of limb anomalies, their          on the date of last menstruation period and ultrasound examination.
prevalence, associated malformations and outcomes were analysed.            Maternal serum AFP, bhCG, and uE3 were measured by
Results: The overall prevalence of congenital anomalies during the study    radioimmunoassay. The outcome of the pregnancy was evaluated
was 2.3%. Limb anomalies were seen in 41% of fetuses with congenital        prospectively. The statistical analysis was performed by Pearson’s
malformations. Lower limb defects were seen in 60% while in 35%,            correlation and Student’s test.
both upper and lower limbs were involved. The types of anomaly ranged       Results: With the progress of pregnancy (14 to 19 weeks), median
from simple talipes to hemimelia, sirenomelia and amelia. Isolated limb     AFPMS rised from 19.05 to 48.90 ng/ml and uE3MS rised from 0.90 to
defect, mostly unilateral was seen in 15 cases and all except one           3.30 ng/ml, whereas bhCGMS levels decreased from 28485 to 7020
survived. Prognosis was poor in 42 cases with other associated              mUI/ml. Althought the values of these biochemical markers decreased
malformations. In this group, only two survived and that too with           as maternal weight increased (47.70 – 84.00 Kg), a significant negative
developmental delay. Many rare syndromes seen during this period had        correlation (p< 0.05) was observed only with AFPMS and bhCGMS.
associated limb anomalies.                                                  The adjustement of these serum makers levels for maternal weight
Conclusion: Bilateral defects, Combined upper and lower limb defects,       presented a significant difference only for bhCGMS and uE3MS. The
associated malformations of other systems portend a bad prognosis.          median values of the variables studied, after adjustement for maternal
                                                                            weight, did not differ significantly for white and non-white pregnant
                                                                            women (p< 0.05).
P1.01.07                                                                    Conclusions: Maternal serum AFP and uE3 levels increased with
CORRELATION OF CLINICAL PRENATAL FINDINGS WITH                              gestational age, while bhCG levels decreased. Althought all these
THOSE OBSERVED IN FETAL AUTOPSIES IN HUNGARY.                               maternal serum marker levels decreased with increasing maternal
B. Veszprémi 1, L. Kaiser 2, M. Vizer 1, A. Arany 1, L. Pajor 2,            weight, after adjust them by maternal weight only bhCG and uE3
G. Vereckei 1, I. Szabó 1, Departments of Obstetrics and Gynecology 1       presented a significant difference. After adjustement of the maternal
and Pathology 2, University Medical School of Pecs, Hungary                 weight we did not detect any influence of skin color (white and non-
                                                                            white pregnant women), on these maternal serum makers. It is very
Our object was to provide a comprehensive description of the clinical       important to stablish values of normality for these markers in the third
and pathological findings of 121 therapeutic abortions (12-24 gestational   world, where the majority of pregnant women begin prenatal assistance
week) in a period between 1992 and 1998.                                    very late.
78                                                                                                                      MONDAY, SEPTEMBER 4

P1.01.09                                                                      investigation and individual counselling to get the proportion of women
PERINATAL PROGNOSIS (ORIGINAL METHOD)                                         receiving the standard quality of antenatal care. Hemoque
S. Vitushko, M. Fedorova, V. Petrukhin, V. Gurieva, F. Burumkulova,           hemoglobinometer operated by trained observers was used as a golden
Moscow Regional Scientific Research Institute of OB/GYN, Moscow,              standard for prevalence of anemia.
Russia                                                                        Results: The majority of pregnant women (58%) were not checked for
                                                                              anaemia at all. Only 9.5% were clinically examined, 36.7% had
Objectives: The aim of our work was to elaborate the new method               hemoglobin (HB) assessed by Tallquist method. Health workers defined
perinatal prognosis on the basis of qualitative and quantitative              a larger proportion of women as moderately anaemic (Hb >8.5 and
assessment of a fetoplacental complex (FPC) function.                         <11g/dl) than the Hemoque. On the contrary, the observers were more
Study Methods: For 65 pregnant women with diabetes mellitus (DM)              likely to identify women with severe anemia than the health workers
during all gestation is conduced not less than 8-9 series of blood            (x% vs Y%). Very few women (8.4%) were given a feedback or action
analyses on 5 parameters: a placental lactogen, progesteron, estriol,         taken on the basis of the results.
cortisol, a-fetoprotein.                                                      Using the observers’ results, the prevalence of anemia was 58%
Results: On parameters of a FPC function, expressed in percentile, for        <10.5g/dl, 25% <8.5g/dl and 6.2% <7g/dl respectively.It can be
each woman was determined the “adaptive corridor”, restricted by              estimated that only XX % of the severely anemic pregnant women in the
lowest and extremely upper (“marginal”) values. It is ground analyses of      area had any benefit from participating in the program.
nature and features of an “adaptive corridor” are discharged 6 signs of       Conclusion: Even if there is an infrastructure and good attendance in
pathological fetus adaptation and different qualitative condition of FPC:     antenatal care, not even the most simple procedures may be adequately
stability, instability, high instability and “attrition”. The dynamics        performed, and thus the health impact of the system will be negligible
accumulation of pathological signs of adaptation has allowed calculating      unless quality is improved.
a coefficient of “deterioration” (CD) of FPC. At CD less than 1.0
perinatal prognosis is favorable, at CD 1.0 and more – is doubtful. The
test-sensitivity of this method has made 80.0% specificity –93.3%.            P1.01.12
Conclusions: The system approach to a series of parameters of a FPC           PHOSPHOISOFORMS OF INSULIN-LIKE GROWTH FACTOR
function has allowed giving both qualitative and quantitative assessment      BINDING PROTEIN-1 IN APPROPRIATE-FOR-GESTATIONAL
of a fetus condition. The definition of stability and CD of FPC as            AGE AND SMALL-FOR-GESTATIONAL AGE FETUSES
systems is new and practically significant method of the perinatal            T. Mochizuki (1), Y. Katsumata (1), T. Hoshiai (1), T. Ozaki (1),
prognosis for the pregnant woman with DM.                                     T. Yazaki (1), M. Iwashita (1), Y. Nakamura (1), K. Maruyama (2), H.
                                                                              Aoki (3)
                                                                              (1) Dept. OB/GYN, Kyorin University School of Medicine, Tokyo,
P1.01.10                                                                          Japan
DISTRIBUTION OF PERINATAL MORTALITY RATES IN TWO                              (2) Yoshida Clinic, Saitaima, Japan
REGIONS OF RUSSIA USING NORDIC-BALTIC PERINATAL                               (3) Dept. OB/GYN, Fussa Hospital, Tokyo, Japan
S.V. Pavlovitch (1), E.M. Vikhlyaeva (1), L.V. Posiseeva (2), T.P.            Objectives: The aim of the study is to analyze phosphoisoforms of
Vasilyeva (2), K.G. Serebrennikova (3)                                        insulin-like growth factor-binding protein-1 (IGFBP-1) in maternal and
(1) Research Center of Obstetrics, Gynecology and Perinatology,               cord sera from pre-term and term fetus with different growth status.
     Moscow, Russia                                                           Study Methods: Phosphoisoforms were separated by non-SDS-
(2) Ivanovo Research Institute of Obstetrics and Pediatrics, Ivanovo,         polyacrylamide gel electrophoresis and detected by immunoblot.
     Russia                                                                   Phosphoisoforms were also analyzed by anion exchange
(3) Izevsk medical academy, Izevsk, Russia                                    chromatography on HPLC.
                                                                              Results: The proportion of nonphosphorylated IGFBP-1 to total IGFP-1
Objectives: To analyze the structure of the perinatal mortality in the        was significantly higher in pre-term fetus than their mothers, however,
European part of Russia using Nordic-Baltic Perinatal Death                   the relative amounts of each IGFBP-1 isoforms were similar between
Classification (NBPDC) with evaluation of the risk rates for each of the      pre-term and term fetus. The levels of nonphosphorylated IGFBP-1 were
categories of that Classification.                                            similar between appropriate for gestational age (AGA) and small for
Study Method: The study has been undertaken in the framework of the           gestational age (SGA) fetus at term, however, phosphorylated isoforms
WHO project #95909. All cases of perinatal losses in 1998 in Ivanovo          of IGFBP-1 were increased in SGA fetus compared to those of AGA
region and Republic of Udmurtia (153 and 227 cases correspondingly)           fetus and the proportion of nonphosphorylated IGFBP-1 to total IGFBP-
and their distribution according to the 12 categories of the NBPDC had        1 was lower in SGA fetus than those in AGA fetus.
been analyzed with the “PND” computer program (author – Dr. S.                Conclusions: The profiles of nonphosphorylated and phosphorylated
Larsen, Denmark). Perinatal death rates, total risk rates and deaths risk     IGFBP-1 in the fetus varies corresponding to fetal growth suggesting
rates were evaluated for each of the classification categories.               that not only total amounts of IGFBP-1 but also the proportion of
Results: Significant differences between regions have been revealed in        phosphoisoforms of IGFBP-1 is important for fetal growth.
the perinatal death rates in neonatal (VIII-XII) categories, especially for
the newborns with gestational age of 22-28 weeks. Relatively high
indices of the perinatal death and perinatal death risk rates in both         P1.01.13
regions for intranatal (VI) category (1.24; 1.46 and 1.28;1.47,               THE EFFECT OF ANTENATAL PELVIC FLOOR EXERCISE WITH
correspondingly) as well as for VIII-XII categories testify of some           A VAGINAL DILATOR ON PERINEAL TRAUMA DURING
reserves for introducing of the preventive measures.                          CHILDBIRTH: A RANDOMISED CONTROLLED TRIAL.
Conclusions:Application of the NBPDC in perinatal practice is of great        Sørensen L, Nøglebæk J, Nonboe A, Skajaa K, University Hospital of
assistance for detailed analysis of the perinatal losses structure and thus   Aarhus, Skejby Hospital, DK-8200 Åarhus, Denmark
reveal the priorities for improving the perinatal care system.
                                                                              Objective: The aim of the study was to evaluate the effect of antenatal
                                                                              pelvic floor exercise
P1.01.11                                                                      with a vaginal dilator on perineal trauma during childbirth.
ANTENATAL CARE IN RURAL AFRICA – IS THERE A BENEFIT?                          Design: A randomised, single-blind prospective study
D Urassa, Dpt of Community Medicine, University of Dar-es-                    Setting: Midwifery antenatal care centre and the labour ward at the
Salaam,Tanzania A Carlstedt and G Lindmark, Dpt of Women´s and                department of obstetrics and gynaecology at Aarhus University Hospital.
Children´s Health, Uppsala,Sweden                                             Participants: From August 1998 to December 1999 five hundred and
                                                                              twenty-five nulliparous women with singleton pregnancy and fulfilling
Objective: To assess the ability of antenatal care to improve common          the entry criteria to the trial were randomised by a automated voice
health problems such as anemia in a developing country.                       response programme to one of two groups. Group one was assigned to
Methods: We observed and interviewed 379 women from 16 randomly               pelvic floor exercise ten to fifteen minutes twice daily from thirty-five
selected antenatal clinics in Rufiji district, Tanzania with respect to the   week of pregnancy to delivery, and group two was assigned to no
care received. Process quality was assessed for clinical and laboratory       exercise. The pelvic floor exercise consisted of isometric contractions of
MONDAY, SEPTEMBER 4                                                                                                                                  79

the perineal and vaginal muscles against a balloon device, which was          P1.01.15
enabled to a stepwise dilatation from 3 to 10 cm. The women were              PRENATAL DIAGNOSIS AND OUTCOME OF SKELETAL
instructed not to tell anything about the trial at the labour ward, and the   DYSPLASIAS
midwife who took care of the women at birth was not aware of to which         Calda P., Baxova A., Zizka Z., Krepelova A., Hruskova, H., Fait, T.,
group the woman was belonging.                                                Pavlista, D., Plavka, R.
Results: 257 women were allocated to exercise and 261 to no exercise.         First Medical Faculty, Charles University, Department Of Obstetrics
14.3% and 10.7%, respectively, were delivered by planned or acute             And Gynecology, Prague, Department of Biology And Clinical
caesarean section. Among the rest bivariate comparison showed that            Genetics, Czech Republic
exercise did not affect the frequencies of episiotomy (14.5% vs 16.3%)
or perineal lacerations grade 2 or more (5.9% vs 9.2%). The analysis          Objectives: Skeletal dysplasias (SD) (osteochondrodysplasias) are a
was performed due to the intention to treat principle. An analysis            heterogeneous group of rare but important genetic disorders
excluding participants who dropped out or did not exercise adequately         characterized by abnormal growth and development of bone and
did not change these results. A logistic regression model showed that         cartilage. Family history, DNA diagnostics and ultrasonographic
birthweight above 3800 grams, as the only variable, indicate a                findings can identify fetuses with SD.
significantly higher risk of perineal lacerations grade 2 or more (Odds       Study methods: We describe the prenatal diagnosis (sonographic, DNA)
ratio 1.7).                                                                   and outcome of 22 cases of SD evaluated between January 1996 and
Conclusion: antenatal pelvic floor exercise with a vaginal dilator had no     2000. All reported cases were documented after abortion or delivery by
effect on the risk of perineal trauma during childbirth.                      skeletal radiography and where possible confirmed with DNA
                                                                              Results: 1 case of SD presented at delivery with no prenatal diagnosis,
P1.01.14                                                                      while the remaining 21 cases were identified antenatally. Final
MRI AS AN ADDITION TO ULTRASONOGRAPHY IN IMAGING                              diagnoses included thanatophoric dysplasia (6), osteogenesis imperfecta
FETAL MIDLINE ANOMALIES IN CENTRAL NERVOUS SYSTEM                             (9), campomelic dysplasia (1), achondroplasia (3), diastrophic dysplasia
Jaana Poutamo, Ritva Vanninen*, Kaarina Partanen*, Pauli Vainio*,             (1) and 2 inaccurate or nonspecific diagnoses. 17 out of 22 pregnancies
Pertti Kirkinen†                                                              were terminated, 1 was aborted spontaneously, and 4 pregnancies went
Dept. of Obstetrics and Gynecology, Middle Finland Central Hospital,          on to delivery. The identification of SD was (95%) (21/22) but only 50%
Keskussairaalantie 19, 40620 Jyväskylä, Finland, *Dept. of Clinical           (11) were given an accurate specific antenatal diagnosis. The remaining
Radiology, and †Dept. of Obstetrics and Gynecology Kuopio University          cases of thanatophoric dysplasia (4), diastrophic dysplasia (1) and
Hospital, PO Box 1777, 70211 Kuopio, Finland                                  osteogenesis imperfecta (4) were identified by ultrasound, but final
                                                                              diagnosis was possible using complex diagnostic methods. DNA
Objective. To study applicability of MRI as a complementary imaging           analysis confirmed diagnosis of 10 cases of thanatophoric dysplasia and
method in examination of fetal central nervous system midline anatomy         achondroplasia.
and abnormalities.                                                            Conclusions: Accurate antenatal diagnosis of SD was possible in 50% of
Material and methods. The study consisted of 26 pregnant women with           all cases, clinical examination, molecular DNA analysis, radiographs
27 fetuses, which underwent MRI examination (1,5 T) at the end of the         and autopsy are mandatory for making a specific diagnosis. Work was
second trimester of pregnancy (n=2) or in the third trimester (n=25)          supported by grant IGA MZCR M/25-3.
(Mean 33 weeks, SD 3,6 weeks; range 27-42 weeks). The first sign of
central nervous system malformation by ultrasonography was found in
average 30 gestational weeks (SD 6 weeks, range 11-37 weeks). The             P1.01.16
finding in postpartum reference studies was ventriculomegaly in 21 cases.     PREGNANCY OUTCOME IN FRAGILE X CARRIERS
Additionally, the series comprised of single cases of Dandy-Walker cyst,      Seppo Heinonen, Juuso Kallinen, Kati Korhonen, Saara Kortelainen,
subdural hematoma, tumor in right hemisphere, choroid plexus cyst,            Markku Ryynänen, Department of Obstetrics and Gynecology, Kuopio
microcephaly and Siamese twin with confused brain. Accuracy of the            University Hospital and Kuopio University
antepartum ultrasonography and MRI to image corpus callosum, cavum
septum pellucidum, cavum Vergae and midline blood vessels was                 Objective: To evaluate pregnancy outcome measures in fragile X carrier
compared.                                                                     women.
Results. Correct antepartum diagnosis of corpus callosum abnormality          Sample: Methods: In this cross-sectional case-control study we analyzed
was done on ultrasonography in 3 cases out of 9 cases and on MRI in 7         63 singleton deliveries among fragile X carrier women who were
cases. Abnormal cavum septi pellucidi was correctly imaged on both            referred for genetic counseling and prenatal diagnosis to Kuopio
imaging methods in 3 cases out of 5 cases. Also enlargement of cavum          University Hospital. Logistic regression analysis was used to compare
Vergae was found in all 3 cases on both imaging methods. A cranially          pregnancy outcome of this group with that of the general obstetric
dislocated vermis cerebellaris was correctly diagnosed on MRI but not         population.
on ultrasonography.                                                           Results: Fragile X carriers were more often parous women than the
Conclusions. MRI is applicable addition to ultrasonography in imaging         general obstetric population, and they also more often experienced late
fetal midline anatomy in malformed fetal central nervous system.              pregnancy bleeding than did the reference group. Otherwise, the course
Maternal sedation with peroral oxazepam was used in two cases in CNS          of pregnancy and outcome measures were comparable in both groups.
malformation group and in three cases in control group.                       Conclusion: Pregnancy outcome in fragile X carrier mothers is
Ttransabdominal fetal intramuscular curarization with pancuronium             favorable, and there is no need to initiate special fetal monitoring
bromide (0.1 mg/kg) was used in two cases with CNS malformed fetus.           because of carrier status.
None of the mothers or fetuses, which were imaged with HASTE and
TRUE-FISP sequencies received sedation or curarization in CNS
malformation group, but three mothers in comtrol croup were sedated.          P1.01.17
The mother was lying in a left semi-recumbent position and two or three       MECHANISM OF ACTION OF A HERBAL FORMULATION IN
breath-hold sequences were used in the different fetal orthogonal             IMPROVING FETAL OUTCOME.
imaging planes. The whole MRI examination sessions were completed             H.S.Palep (1), L.Palep (2), A.Palep (2), (1) Grant Medical College,
within 40 minutes by Magnetom SP4000 equipment and within 20-30               Manoj C.H.S., Shankar Ghanekar Marg, Mumbai, Maharashtra, India,
minutes by Magnetom Vision equipment. Antepartum US and MRI                   400025, (2) Dr.Palep’s Medical Research Foundation, Mumbai,
findings were compared with the findings in postpartum US, computed           Maharashtra, India.
tomography (CT) or MRI. Clinical, surgical and autopsy findings were
also used as reference. (Aloka 2200 equipment, 5.0 MHz convex                 Objective: A herbal formulation Cap.Sujat (AYURVEDA) showed
transabdominal probe and a vaginal 6.0 MHz probe)                             excellent results in terms of Pregnancy outcome, reduced the incidence
                                                                              of PIH, Perinatal Mortality, Morbidity & improved Fetal weights at
                                                                              birth. A good Fetal weight at Birth is an insurance against the
                                                                              development of Atherosclerotic Cardiovascular disorders, Hypertension,
                                                                              D.M type II.
                                                                              Objective-what was the cause of such a good clinical result?
80                                                                                                                   MONDAY, SEPTEMBER 4

Study Method: Rat liver Mitochondria were isolated and subjected to        predominance and FNO-a production increase is attributable for this
Oxidative damage using Radiation, Ascorbate Fe+_ system and                process.
Peroxynitrate. Sujat conc.of 0.01%, 0.05% & 0.1% were used and
checked for their protection against Oxidative damage. Damage was
measured using TBARS(Thiobarbituric acid reactive substances) assay.       P1.02 BIRTHING
Sujat was compared with Trolox & Glutathione in its efficacy as an
Anti-oxidant.                                                              P1.02.01
Atomic Absorption Spectroscopic(AAS) studies were done for -               ADOLESCENT VERSUS MATURE GRAVIDA. PREGNANCY AND
Micronutrients viz; Ca++, Mg++ etc.                                        LABOR AT THE EXTREMES OF THE REPRODUCTIVE AGE IN
HPTLC studies were conducted to see if it has any g-Linoleic Acid          DIFFERENT BALKAN COUNTRIES.
(GLA) activity.                                                            G.Manidakis, S.Sifakis, K.Relakis, G.Froudarakis, I.Mataliotakis,
Amino Acid content were studied.                                           A.Goumenu, A.Manidaki. E.Koumantakis Department of Obstetrics and
Results: Sujat in conc.of 0.1% showed itself to be a Super Anti-oxidant    Gynecology, University Hospital of Heraklion Crete Greece.
with 96% inhibition compared to controls.                                  L.Dracea, A.Tomasu, D.Ionita, S.Puia, B.Marinescu. Department of
AAS showed that it contained good conc.of Ca++ & Mg++.                     Obstetrics and Gynecology, University Hospital “Prof.Dr.Panait
HPTLC compared with GLA120 showed similar Peaks confirming the             Sirbu”Bucharest Romania.
presence of GLA.
Amino acid sequence study showed 15 Amino acids and 9 Essential            Objectives: We performed a retrospective study (1995-1999) of
A.A. 28% of the content of Sujat is Protein. It contains Arginine(NO       deliveries related to young and very young adolescent mothers,
substrate) in good conc.                                                   compared with advanced and very advanced maternal age in Two
Conclusion: Sujat is an effective agent for comprehensive Antenatal care   University hospitals in Heraklion Crete Greece and Bucharest Romania.
because of its nutritional value, Arginine, GLA and Anti-Oxidant action    Study Methods: Four groups of gravidas where compared in both
at the level of Placenta.                                                  countries: age group 13-17 with age group 18-19 and age group 39-40
                                                                           with age group 41-46.
                                                                           Results: Deliveries by teenagers were more often spontaneous and less
P1.01.18                                                                   often needed obstetrical intervention. In Crete cesarean section rate was
OVARIAN HYPERSTIMULATION SYNDROME (OHSS) IN A                              8% in age group 13-17 and 10% in age group 18-19, compared with a
SPONTANEOUS SINGLETON PREGNANCY: A CASE REPORT                             significantly lower 1,5% and 3,8% in Romania.
A.Amini, F.M.D. Kheshti, M.H. Badakhsh, Dept. OB.GYN, Firozgar             Deliveries in advanced and very advanced maternal age needed more
Hospital, Iran Medical School, Tehran, Iran.                               often obstetrical intervention than deliveries in younger mothers. In
                                                                           contrast with the adolescent gravidas the cesarean section rates were not
Objective: Presenting a case of ovarian hyperstimulation in a singleton    different statistically in the two countries. High cesarean section rates
normal pregnancy.                                                          (30% to50%) were noted in maternal age group 39-40 and in age group
Study Methods: A case presenting.                                          41-46 ,in Greece and Romania as well.
Results: Ovarian hyperstimulation may be seen in a normal spontaneous      Emergency postnatal hysterectomy was greater 3% in age group 41-
pregnancy.                                                                 46,compared with 1% in age group 39-40 in Bucharest. One case of
Conclusions: The same as result.                                           emergency prenatal hysterectomy because of spontaneous uterine
                                                                           rupture in the second trimester of pregnancy (25 weeks) was noted in a
                                                                           42 years old IVF primipara in Crete.
P1.01.19                                                                   Conclusions: Although the medical complication of pregnancy and birth
IMMUNOMORPHOLOGICAL MODIFICATIONS IN DECIDUAL                              in adolescents can be minimized with good management and follow up
TISSUE IN DEVOLUTION PREGNANCY WITH UROGENITAL                             the social and psychological implications continue to take a tool. Social
AND CHLAMYDIA INFECTIONS                                                   and medical system characteristics may contribute to the appearance of
E.M. Demidova, A.V. Mescheryakova, I.N. Voloschuk, M.U.                    differences between the two countries concerning the adolescent
Rzhavskov, Moscow Medical Academy, Clinic of Midwifery and                 pregnancy. This observation is in contrast with the advanced maternal
Gynecology, Moscow, Russia.                                                age group, which had similar obstetrical outcome in Greece and
Objectives: Discover how often women with the devolution pregnancy
and immunomorphological modifications in the decidual tissue have the
chlamydia urogenital infection.                                            P1.02.02
Study Methods: 75 women at 7-12 weeks of pregnancy have been               FETAL, NEONATAL AND MATERNAL OUTCOME RELATED TO
examined: 60 women (55% of them with habitual missed abortion) with        ADOLESCENT PREGNANCY: INTER-UNIVERSITY RESEARCH
the confirmed diagnosis of devolution pregnancy and 15 somatically         IN DIFFERENT BALKAN COUNTRIES
healthy women with unburden midwifery-gynecological anamneis who           G.Manidakis, S.Sifakis, G.Froudarakis, E.Angelakis, K.Relakis,
applied to the clinic for instrumental abortion. Investigation of the      I.Matalliotakis, A.Goumenou, A.Manidaki, E.Koumantakis. Department
decidual tissue swab-stamp for defection of Chlamidia Trachomatis          of Obstetrics and Gynecology, University Hospital of Heraklion Crete
antigen by means of direct immunofluorescence antibody testing with        Greece. L.Dracea,A.Tomasu,D.Ionita,S.Puia,B.Marinescu Department
monoclonal antibodies (HEMIFLURAN). Immunohistochemical                    of Obstetric and Gynecology , University Hospital “Prof.Dr. Panait
investigation of the decidual tissue using monoclonal antibodies to        Sirbu”Bucharest Romania
CD68 (macrophage marker), C56 (large granulation lymphocytes
marker), cytokeenes IL-10 and FNO-a (Sigma, USA).                          Objectives: We performed a retrospective study of birth related to
Immunoperoxydasa (streptovidin-biothyn) method.                            adolescent gravidas in two University Hospitals from Greece and
Results: Chlamydia Trachomatis in decidual tissue was found in 52% of      Romania to determine the factors that affect the labor and obstetrical
women examined with devolution pregnancy, in 7% of women with              outcome in different Balkan countries
instrumental abortion. According to the physiological uncomplicated        Study Methods: Birth related to adolescent mothers represented 7% in
pregnancy we found the following subpopulation of the decidual             Heraklion and 9,1% in Bucharest from a total of 4009 and 10534 births
lymphocytes: CD56 – 23.4±8.75; CD68 – 8.2±4.57. Correlation of the         respectively, between 1995-1999.Two groups of adolescent gravidas
populations of these cells was 3/1 (CD56/CD68). In case of the             were compared: age group 13-17 and age group 18-19.
devolution pregnancy with the chlamydia persistence in endometrium         Results:Deliveries by teenagers were more often spontaneous and less
we discovered the sharp lowering level (3 times) of CD56 – 4.9±4.4 and     often needed obstetrical intervention than deliveries in older mother in
absolute rising number of the CD68 macrophages in 2 times – 11.8±4.6.      both countries but cesarean section rate was greater in Greece: 8% in age
Correlation of the cells causes the macrophages to become the main         group 13-17 and 10% in age group 18-19, compared with only 1,5% and
population in the decidual tissue.                                         3,8% in Romania.
Conclusions: The devolution pregnancy with the infection persistence in    Neonates with low birth weight under 2500gr and Apgar score lower
endometrium passes with alterations in the structure of subpopulation of   than 8 were more frequent in age group 13-17.
the decidual tissue immunocompetent cells. The macrophage
MONDAY, SEPTEMBER 4                                                                                                                                  81

Intrauterine deaths and major malformation related to adolescent             P1.02.05
gravidas (13-17 and 18-19 age groups) represented 0,6% in Heraklion          LABOR AFTER A PERIOD OF INFERTILITY
and 1% in Bucharest. Intrauterine deaths were more frequent in               S.Stanisic, M. Dunjic, N. Sulovic, S. Slavica, OB/GYN University
Bucharest in age group 18-19(8 cases). In contrast, no cases of              Clinic, School of Medicine Pristina, Belgrade, Yugoslavia
intrauterine death were noted in age group 18-19 adolescent mothers
from Crete.                                                                  Objectives: Aim of study is to examine the effect of a previous state of
Conclusions: Further inter-university research into determinants of          infertility on the delivery.
outcome of teenage pregnancy, as specific age groups cultural                Study Methods: In the study are included 93 women who gave birth
background, socioeconomic status and life stile is indicated. Obstetrical    after 3-18 (X = 7.3, SD = 3.7) years of infertility. The control group
complication of pregnancy and birth in adolescents can be minimized          consist of each consecutive birth without a history of infertility. All
with good management and follow up including observation and                 women are nulliparous without illness which may adversely affect the
monitoring in a well organized “fetal-maternal unit”.                        pregnancy or the fetus. Statistic significance of results was established
For adolescent who became pregnant, social and psychological support         by X2 test.
must be provided in addition to medical care.                                Results: In 1997, we had 9030 births on University Clinic of OB/GYN
                                                                             in Pristina with 93 (1.03%) cases of pregnancies with history of
                                                                             infertility. From the study are excluded 4 women with twins and 11
P1.02.03                                                                     cases with different diseases. In the study group of 78 women after
BACTERIOLOGIC FINDINGS IN BABIES DELIVERED IN                                infertility, the rateof premature labor was 5.4% which is significantly
WATER.                                                                       lower than the incidence in all primiparous women (8.2%). Cesarean
K. Toftager-Larsen, L. Nymann, C. Hogdall, J. Sandoe, P. Odgaard,            sections are performed in 52.56% of women with history of infertility. In
Dept. OB/GYN, Roskilde County Hospital, DK-4000 Roskilde & N.                the group scheduled for vaginal delivery, the emergency SC was 27%.
Frimodt-Møller, Dept. Microbiology, the State Serum Instutute, DK-           Indications for the elective SC were elderly primiparous, disproportion,
2300 Copenhagen S, DENMARK                                                   inadequate presentation and lay and breech presentation, while in
                                                                             emergency SC dystocia and asphyxia. There is not a difference in the
Objectives: Our aim was to investigate potential risks of infection by       features of the vaginal labor in the study and control groups. The
delivering in water by determining the bacteriology in babies delivered      neonates from women with and without infertility are similar in weight,
in water and delivered “dry”, and in the tub water.                          height and Appgar score.
Study methods: Swabs were taken from the ear, nose and umbilical cord        Conclusion: After period of infertility there is a high rate of SC. The
of 100 babies delivered in water and of 100 matched controls delivered       infertility has not adverse effect on the course of the vaginal labor and
“dry”. In thirty six cases tub water samples were taken before and after     the state of the newborns, without others indications.
Results: Growth of bacteria were found in samples from the ear, nose
and umbilical cord in 17, 5, and 6 samples from cases, and in 19, 10, and    P1.02.06
9 samples from controls, respectively. Thus, there was no difference         COMPARATIONS OF APGAR SCORE WITHIN SQUATTING AND
between cases and controls. Neither was any difference found with            HORIZONTAL MOTHER CHILDBIRTH IN LOW RISK PREGNANT
respect to “faecal” bacteria between the two groups.                         WOMEN
Growth of more than 105 bacterial colonies per ml was found in the tub       H.Sabatino; Souza; E.Z.Martinez; Dept.OB/GYN. Univ.of
water in three and eleven of the 36 samples taken before and after           Campinas. Brazil
delivery, respectively. In spite of this, no connection at all between
bacteriologic findings in water cultures and findings in ear, nose and       Objectives: Compare Apgar distribution at the first minute of life, in 581
umbilical cord samples was found.                                            births with mothers in the squatting position, among the Group
Conclusions: Delivery in water does not seem to carry an increased risk      Alternative Childbirth’s program (GAC); and 8,810 conventional birth
of infection for the baby, judged by the bacteriologic findings in water     positions (horizontal) not belonging to this group (NGAC). The
and land deliveries.                                                         childbirth’s were in similar periods.
Although bacteria are found in tub water after delivery, these are not       Study Methods: All the women participating in this research had a low
reflected in bacteriologic findings in the baby.                             risk gestation, a vaginal childbirth and just one foetus in cephalic
                                                                             position. They were greater than 36 weeks of gestation, and the newborn
                                                                             had weight between 2,000 to 5,000g. The mothers were not illiterate and
P1.02.04                                                                     they did not have a history of convulsions and weren’t alcohol or drug
THE IMPACT OF INDUCITON OF LABOR ON OBSTETRIC                                users. Meconium, tachycardia, late decelerations or other signs of fetal
INTERVENTION IN THE UNITED KINGDOM                                           distress were not present during the first and second stages of labor. We
S. W. Lindow, M. P. O’Connell, Dept. OB/GYN, Hull Maternity                  exclude from the study women who had up to 6 previous childbirth’s
Hospital, Hull, UK                                                           and had 4 or less prenatal care, with fetal malformation and gestation
Objectives: To determine the pattern of obstetric intervention in the UK
in 1997 in relation to induction of labor.                                     Results
Study Methods: We reviewed the annual statistical returns to the Royal
College of Obstetricians and Gynecologists for 1997 (222 units).
                                                                                                     GAC                          NGAC
Specific attention was made to the rates of assisted vaginal delivery,         APGAR          n        %        %c          n       %        %c
Caesarian section and induction of labor.
The rates of intervention were correlated with each other and with unit          0             0      0.0   0.0              8    0.1   0.1
size and perinatal mortality.                                                    1             1      0.2   0.2             35    0.4   0.5
Results: The rates of assisted vaginal deliver correlated with the rate of       2             0      0.0   0.2             46    0.5   1.0
Caesarian section (P<.01).                                                       3             0      0.0   0.2             46    0.5   1.5
The rates of induction of labor did not correlate with any intervention
nor with the parinatal mortality rate.
                                                                                 4             2      0.3   0.5             96    1.1   2.6
The units with the highest normal vaginal deliver rate tended to be              5             2      0.3   0.8            120    1.4   4.0
smaller (2505 v 3278 deliveries) and did not have a lower induction rate         6             4      0.7   1.5            117    1.3   5.3
(20.2% v 20%) than the units with a low normal delivery rate.                    7            23      4.0   5.5            345    3.9   9.2
Conclusions: Units with a high induction rate did not demonstrate any            8           166     28.6 34.1            3618 41.1 50.3
increase in intervention or any difference in perinatal mortality.
A philosophy of intervention was evident in some units, which led to             9           326     56.1 90.2            4135 46.9 97.2
high rates of intervention across the spectrum of procedures.                    10           57      9.8 100.0            244    2.8 100.0
                                                                               TOTAL         581    100.0                 8810 100.0
                                                                               Kolmogorov-Smirnov test: p<0,001
82                                                                                                                        MONDAY, SEPTEMBER 4

Conclusions: The results suggest that in 85 million childbirths, of low         depressed mood (1.2%) were also detected. About 0.4% of participants
risk gestation born in one year period in developing countries, when the        suffered generalized anxiety disorder (of less than 6 months duration),
mother adopts the horizontal outcome(NGAC) resulted in 5,3% of                  and one participant was diagnosed as a double depression at three
depressed new-born (Apgar less than 6) that is to say 4,505,000 babies,         months postpartum. All together, 13.5% (95% CI 8.0% - 19.0%) of
and 1,5% of very depressed new born (Apgar less than 3) that is to say          participants suffered one or more forms of psychiatric disorders in the
1,275,000 babies. When the mother is in the squatting position (GAC)            first three months postpartum.
result suggest 1,5% of depressed new-born (Apgar less than 6) that is to        Conclusions: This is the first large scale methodologically sound
say 1,275,000 babies and 0,2% of very depressed newborn (Apgar less             epidemiological study completed on the prevalence of major
than 3). This shows us that we could save 3,230,000 newborn from the            psychological morbidity in a postnatal Chinese population.
reanimation possibility and from the neonatal depression consequences
in the first minute of life. We could also avoid nearly 1,105,000 very
depressed newborns.These results encouraged us to begin a                       P1.02.09
collaborative, prospective and randomized study in several maternity            SCREENING POSTNATAL DEPRESSION USING DOUBLE TESTS
wards with childbirth’s assisted with in squatting and litotomy position        T. Chung, Dept. OB/GYN, Chinese University of Hong Kong, HK SAR,
coord. by Univ. UNICAMP.                                                        China.

                                                                                Objectives: Postnatal depression affects 10 to 20 percent of women after
P1.02.07                                                                        childbirth. To facilitate early detection, self-reporting psychological
DESIGNING A NEW SCALE NAMED "DESCENTMETER" (DM)                                 questionnaires have been validated and applied to women following
FOR MEASURING THE PROGRESSIVE DESCENT OF FETUS IN                               confinement. We hypothesize that by applying two complementary
LABOUR                                                                          screening tests simultaneously (a double test), the positive predictive
A.Debdas, Telco Maternity Hospital, Telco Colony, Jamshedpur, Bihar,            value of the screening instrument can be significantly enhanced.
India, 831004.                                                                  Study Method: Prospective cohort study was conducted at the postnatal
                                                                                clinic of a university teaching hospital. One hundred and forty-five
Objective: Introduction of a hard objective method (no clinical guess) to       Chinese women completed the Edinburgh Postnatal Depression Scale
asses fetal descent in labour because none exist today. Current method          (EPDS) and 12-item General Health Questionnaire (GHQ), and were
of correlating descent with ischial spines have problems like – a) spines       then interviewed by a psychiatrist using the Structured Clinical
not easy to locate, b) needs a lot of skill and experience, c) have wide        Interview for DSM-III-R (SCID). The SCID interview established the
individual variation and d) is painful for the patients.                        gold standard diagnosis for validation.
Method & result                                                                 Results: The positive predictive value of the EPDS and GHQ, when
I. Finding a superficial alternative to ischial spines – Of the 3 choices       applied independently, was 44% and 52% at their respective optimal cut-
namely ischial tuberosity, tip of sacrum and lower border of symphysis          off scores. When the EPDS and GHQ were used simultaneously to
(LBS) – the LBS was found to be the best choice because of the                  define high scorer (EPDS-GHQ double test), the positive predictive
following reasons - it is easily visible (1cm) above external urthral           value was increased to 78%.
meatus), easily palpable, is a bony fixed point, is a single point and          Conclusions: Simultaneous application of the EPDS and GHQ can
hence allows easier relating, is a midline structure hence amenable to          substantially improve prediction in screening for postnatal depression.
more direct relating and, most importantly, it is the final exit point of the
head/breech from pelvis.
II. Designing the Descentmeter (DM) – One end of a 30 cm rounded                P1.02.10
Taflon rod was calibrated upto 10 cm in 0.5 cm steps – 10 cm because            THE IMPACT OF GESTATIONAL FACTORS ON UMBILICAL
both vaginal and sacral length is 10 cm.                                        CORD BLOOD AVAILABLE FOR TRANSPLANTATION
III. How to take reading by DM – The calibrated end is introduced               D.V.Surbek, U.Aufderhaar, A.Tichelli, A.Wodnar-Filipowicz,
inside the vagina under guidance of vaginal fingers and guided to rest          A.Gratwohl, W.Holzgreve, Depts. of OB/GYN, Hematology and
perpendicularly on the lowest point of the head with its handle directed        Research, University Hospital, Schanzenstrasse 46, 4031 Basel,
straight towards the feet of the patient. In this position the device rests,    Switzerland
in fact stretches, the fourchettes posteriorly and lies roughly at the
central axis of the outlet which lies approximately 5 cm posterior to LBS       Objectives: To determine if gestational and peripartum factors have an
(the AP diameter of outlet being 10.5 cm). Now, with DM held in right           influence on umbilical cord blood (CB) collected at delivery for the
hand the index finger of the left hand is placed vertically over the            purpose of hematopoietic stem cell transplantation
external urethral meatus with its tip pointing towards the anus till it         Study Methods: CB was collected using a closed blood-bag system by
touches the DM rod perpendicularly. The cm mark at the touch-point              puncturing the umbilical vein after cord clamping. CB volume,
constitutes the DM reading which denotes that the presenting part is so         nucleated cell (NC) count, relative and absolute number of CD34+
many cm away from LBS – the final exit point. As the fetus would                progenitor/stem cells (by FACS), and proliferative capacity of
descend the DM reading would decrease.                                          progenitors (by colony-forming assay / methylcellulose cultures) were
                                                                                determined. A total of n=167 CB samples from normal term deliveries
                                                                                (n=94), preterm deliveries (n=45, postdate gestations (n=9), pregnancies
P1.02.08                                                                        affected by preeclampsia (n=11) or gestational diabetes (n=8) were
A PSYCHIATRIC EPIDEMIOLOGICAL STUDY OF POSTPARTUM                               compared. Additionally, intrapartum variables such as duration of labor
CHINESE WOMEN                                                                   and ruptured membranes, meconium-stained amniotic fluid, fetal
T. Chung, Dept. OB/GYN, Chinese University of Hong Kong, HK SAR,                acidemia, and mode of delivery were compared among the normal term
China.                                                                          delivery group.
                                                                                Results: CB volume and total NC count showed a linear correlation with
Objective: To determine the prevalence of major psychological                   gestational age. However, among preterm deliveries, there was no
morbidity in Hong Kong women following childbirth.                              gestational age-dependent difference in the total CD34+ cell count per
Study Method: A prospective cohort study of 956 women recruited in              CB sample due to an inverse relationship of CD34+ cell frequency
the antenatal clinic. At three months postpartum, the participants              among NC, and up to 77% of samples would have been suitable for
completed General Health Questionnaire (GHQ). Then, all participants            transplantation into a recipient <20kg bogy weight. CB samples from
who scored high on the GHQ (>=5) were assessed by a psychiatrist                postdate pregnancies and preeclamptic patients had a significantly
using non-patient version of the Structured Clinical Interview for DSM-         smaller volume and NC count, the former in comparison with term
III-R (SCID-NP). Ten per cent of the participants who scored below the          deliveries, the latter in comparison with gestational-age matched non-
4/5 cut-off were randomly selected to receive the SCID-NP interview to          preeclamptic controls. No statistically significant differences were
determine the rate of false negatives. Three-month prevalence rates were        detected for gestational diabetes (birth-weight adjusted values) and
estimated using reverse weighting                                               intrapartum parameters except a higher CB volume and NC count in
Results: The 3-month prevalence rates for major depression and minor            deliveries with meconium staining.
depression were 6.1% (95% CI 2.1% - 10.1%) and 5.1% (95% CI 1.1% -              Conclusions: Our study shows that gestational factors influence CB
9.1%) respectively. Dysthymia (0.7%) and adjustment disorders with              samples obtained for stem cell transplantation. These factors should be
MONDAY, SEPTEMBER 4                                                                                                                                      83

accounted for if CB is to be collected for related (sibling) as well as for    Method: Thirty singleton pregnant patients with retained placenta, 1
unrelated banking and transplantation.                                         hour after the baby’s birth, were included after informed consent. A thin
                                                                               infant feeding tube was inserted in the umbilical vein right up to the base
                                                                               of the placenta where the vein is inserted and a solution of 30 ml, which
P1.02.11                                                                       included 10 l of oxytocin i.e. 100 IU and 20 ml of NaCl was injected
THE PARTOGRAPH: WHICH LAG-TIME FOR THE ACTION LINE?                            over 1-2 minutes. An ultrasound examination simultaneously performed
L.J. Van Bogaert, Dept. OB/GYN, Medunsa satellite campus,                      visualized the process of formation of a retroplacental hematoma
Philadelphia Hospital, Dennilton, South Africa                                 followed by the separation and expulsion of the placenta after the
                                                                               injection in 28 patients.
Objectives: To assess the effect of the 3hr and 4 hr lag-time of the action    Results: Twenty-eight i.e. 93.3% patients delivered the placenta within 5
live or low Apgar scores (<7) and/or perinatal death (intra-partum/early       minutes after the injection; there were no side effects. In 2 patients
neonatal)                                                                      where the method did not work, we suspect that the infant feeding tube
Study Methods: Retrospective study of 836 partographs of                       was not inserted right till the end of the umbilical vein thus
primigravidae in active phase of spontaneous labor: 641 spontaneous            compromising the volume of the solution reaching the placenta itself.
vaginal deliveries (SVD), 195 cesarean births (CB).                            Conclusion: A minimum of 30 ml of oxytocin solution reaching the base
Results: Average speed of cervical dilatation (cm/hr) was 1.37 (1.30,          of the placenta via a catheter in the umbilical vein, this obtaining
1.44) with SVD ).56 (0.51, 0.60) with CB (t=12.3; p<0.0001). Average           maximum spread of the drug into the different cotyledons, is the key to
time (min) right of the alert live was 46.6 (39.8, 53.5) with SVD, 183.3       success in the medical treatment for retained placenta.
(164.6, 202.1) with CB (t=16.7; p< 0.0001). Alert line was crossed in
39.7% of SVD, in 92.0% of CB (X2=126.6; p<0.0001)(Or=17.5; 9.4,
32.3). The 3hr action line (but not the 4hr) was crossed in 7.5% of SVD,       P1.02.14
and 52.0% of CB (X2=157.3; p=0.0006)(OR=13.3;8.4,21.2). The 4-hr               DELIVERY AFTER PREVIOUS CESAREAN SECTION
action line was crossed in 5.3% of SVD and 29.3% of CB (c2                     J. Stojkovski, P. Dimcev, A. Shopova, E. Bajalski, Special hospital for
=69.0,p<.0001) (OR=7.4;4.4, 12.4). Low Apgar scores were present in            gynecology an obstetrics “Cair,” Skopje, Macedonia.
1.9% of SVD and 5.6% of CB (c2=11.j9;p=0.0006)(OR=0.33; 0.17,
0.64); perinatal death occurred in 0.4% of SVD, and 0.9% of CB                 Objectives: Analysis of prognosis in deliveries after previous Cesarean
(X2=2.4; p=0.12)(OR=0.33; 0.07, 1.46). Time (min) right of the alert           section (CS).
line with low Apgar score and/or fetal demise was 115.4 (60.9, 170.0)          Study Methods: Retrospective study of 619 deliveries in patients with
with SVD, 104.0 (46.9, 161.1) with CB (t=0.29; p=0.78).                        previous CS in SHGO “Cair” between 1996-1999.
Conclusion: Neonatal outcome is not adversely affected by a 4hr lag-           Results: For 15 839 registered deliveries 618 had undergone previous
time.                                                                          CS (3.9%). The repeated operation was performed in 392 cases (63.4%).
                                                                               Repeated elective CS in 158 (40.3%). The main indications were
                                                                               macrosomy, breech presentation, maternal disease and fetal distress. CS
P1.02.12                                                                       during the trial of labor in 234 (59.7%). Main indications were dystocia
BALLOON VERSUS INTRACERVICAL PROSTAGLANDIN E2                                  and fetal distress. Vaginal delivery was successful in 227 (36.6%).
FOR CERVICAL MATURATION                                                        There were 23 accomplished vaginal operative intervention: 21 (9.3%)
I.Lebbi, S. Mahjoub, R. Ben Hmid, W. Hammami, F. Zouari, “C” Dept.             with vacuum extrator and 2 (0.8%) with Spattulae Thierry. There were
OB/GYN, Center of Maternity and Neonatology of Tunis (CMNT),                   no uterine ruptures and any dehiscences needing surgical treatment. In
Tunisia.                                                                       cases with repeated operations, we report 2 uterine ruptures (0.32%) and
                                                                               4 dehiscences (0.64%) in all scared uterus. There were no maternal
Objectives: The aim of the study was to compare the efficiency and the         deaths nor any perinatal deaths caused by trial of labor.
safety of two types of cervical ripening in case of labor incluction: the      Conclusions: Patients with previous Cesarean section who underwent a
balloon of the foley catheter and the intracervical prostaglandin E2           trial of labor, delivered vaginally in 49%. This result confirm that the
(prepidilR).                                                                   trial of labor in patients with previous CS should be the rule whenever
Study Methods: This prospective study was conducted between January            possible, with known medical history, clinical examinations, maternal
98 and December 98 in “C” dept. OB/GYN of CMNT. It compares two                and fetal monitoring.
groups of patients who had a cervical ripening for labor induction.
Group B including 81 patients ripened by balloon and group Pg
including 20 patient ripened by intracervical prostaglandin E2.                P1.02.15
The choice between the two types of maturation was done randomly and           VAGINAL BIRTH AFTER PREVIOUS CESAREAN SECTION
there were no differences in the two groups either in age, parity,             J. Leibschang, A. Swiatack, J. Kesicka, B. Chazan, Dept. OB/GYN,
gestational age, medical indication of labor induction or initial bishop       National Research Institute of Mother and Child, Warsaw, Poland.
Results: Comparative analysis between B and Pg showed no differences           Objectives: All over the world, cesarean section rates have been steadily
in the mean final bishop score (6.26 vs. 6.45), mean time of maturation        increasing. Then the problem arises as to how to mange subsequent
(10:13 vs. 11:57 hours), mean increase of bishop score (3.85 vs, 4.34)         pregnancies and deliveries.
caesarian section rate (21% vs. 20%) and maternal morbidity                    Study Methods: Between 1993-1998 in the Ob/Gyn. Dept. National
(chorioamnionitis: 3.7% vs. 5%). Therefore, there was a little significant     Research Institute of Mother and Child, 822 women experienced
difference in the rate of spontaneous labor after cervical maturation:         delivery after previous cesarean section. Our policy included initial
16% vs 45%.                                                                    qualification in the third trimester of pregnancy for all those women for
Conclusions: The two types of cervical maturation are similar in               choosing the best possible mode of delivery. This qualification included:
efficiency and safety. The choice between the two types depends only on        past medical and obstetrical history, especially indications for previous
their respective costs. The cost of the balloon is however, cheaper.           cesarean section, general and obstetrical examination and ultrasound
                                                                               examination with special attention to uterine scar (thickness, shape and
P1.02.13                                                                       Results: Initial qualification was finally performed in 777 (94.5%) cases.
VOLUME AND SITE OF INJECTION OF OXYTOCIN SOLUTION                              Each patient signed an informed consent. 540 (69.5%) women were
IS IMPORTANT IN THE MEDICAL TREATMENT OF RETAINED                              initially qualified to undergo trial of labor and 237 (30.5%) for repeated
PLACENTA                                                                       elective cesarean section. Out of 540 patients initially qualified for
P. Chauhan, Dept. OB/GYN, Kolding Hospital, Kolding, Denmark.                  VBAC, 190 (35.2%) finally delivered by emergency cesarean section.
                                                                               350 (64.8%) women successfully delivered vaginally, 9 (2.6%) of them
Objective: A pilot study conducted at Odense University Hospital and           by ventouse. Asymptomatic, partial dehiscence of uterine scar was found
Kolding Hospital, Denmark, to emphasize the importance of the volume           in 7 cases of failed trial of labor. In 4 (1.1%) cases just after vaginal
and the site of injection of oxytocin solution in the umbilical vein for the   delivery, uterine rupture was diagnosed and performance of supravaginal
treatment of retained placenta.                                                hysterectomy was necessary. All “serious complications” appear among
                                                                               patients with ultrasonically diagnosed irregularity or different than “low
84                                                                                                                       MONDAY, SEPTEMBER 4

transverse” shape of uterine scar. We didn’t find any correlation between     b) However, the chance of operative delivery is lower in the epidural
the thickness of the uterine scar and frequency of complications.                 group (24.19% vs 34.05%). This finding is in sharp contrast to
Conclusions: The decision-making process about the mode of delivery               popular belief.
for patients after previous cesarean section requires careful initial         c) There is an increase in incidence of clinical jaundice in both preterm
qualification before labor and accurate intrapartal monitoring of the             (68.90% vs 52.20%) and term infants (46.72% vs 34.96%) in the
mother and fetus’ well-being, ultrasonic evaluation of the shape and              epidural group.
regularity of the uterine scar during late pregnancy seems to be an           d) However, the incidence of severe jaundice necessitating
important element of this qualification, the success of trial labor is more       phototherapy is the same (19.6%vs 20.5%).
frequent among women who experienced at least one vaginal delivery            e) The incidence of clinical jaundice in both groups in term babies was
besides cesarean section in the past.                                             studied according to delivery type. This showed an increased
                                                                                  incidence of jaundice in babies who were delivered by interventions
                                                                                  in both groups.
P1.02.16                                                                      Conclusion: Maintenance of high standard of care in running an epidural
VERTICAL POSITION FOR LABOR CONDUCTION (SOFT                                  analgesia service can give women a safe option.
N.P. Kuznetsova, L.M. Smirnova, A. Borisova, L.I. Ilienka, Dept.
OB/GYN, Sechnow Moscow Medical Academy, Moscow, Russia.                       P1.03 BREAST

Objective: Labor in suitable vertical position represents an alternative      P1.03.01
way of labor conduction. This approach allows women to maintain               MENSTRUAL TIMING OF BREAST CANCER SURGERY
maximum activity during 1st stage of labor. 2nd and 3rd stages take place     A. Hagen (1), W.J.M. Hrushesky (2), A. Ebert (1), F. Opri (1), H.
on a specially equipped bed.                                                  Weitzel (1) Dept. OB/GYN, Free University Berlin, University Medical
Study Methods: 2010 labors in vertical position were conducted in             Center Benjamin Franklin, Berlin, Germany.
Moscow City Maternity Home N4. Patient’s age varied from 17 to 39             (2) Dept. Veteran Affairs, Stratton VA Medical Center, Albany, New
years old. Among them, 785 (39%) were primaparas and 1225 (61%)               York, USA.
multiparas. Uncomplicated current pregnancy course was observed in
1036 (52%) patients. Early signs of pre-eclampsia were seen in 370            Objectives: The aim of the study was to rigorously determine the relative
(18.4%) patients, threatening pregnancy losses in 500 (24.8%) and 104         strength of the hypothesis that the menstrual cycle timing of operation
(5.1%) had myopia (2-10D).                                                    impacts outcome and to determine whether or not a specific change in
Results: It was postulated that in vertical position, the optimal             the practice of breast surgical oncology can be recommended.
coordination of abdominal muscles, pelvic muscles and general skeletal        Study Methods: We made a critical review of 32 retrospective studies of
muscles can be achieved. This allows for the creation of favorable            the outcome of 9.665 women published since 1989, relevant to the
condition for fetus head engagement, physiological conduction of labor        possibility that the timing of primary breast cancer resection within the
and delivery and decreased pain intensity. We noted 2 times shortening        menstrual cycle impacts breast cancer recurrence and/or spread and
of 1st stage, as well as increased length of 2nd stage due to slower and      patient survival. We evaluated the adequacy of information and data
smoother fetus expulsions. This significantly decreased (10 times             analysis in each publication. A global quality score was devised in order
compared to the control group) maternal and baby injuries. There were         to compare the relative completeness of these studies.
no differences in duration and conduction of 3rd stage between the two        Results: The single most completely reported and thoroughly analyzed
groups. All patients delivered in term 2012 liveborn babies (2 patients       series, involving 1.175 patients, indicates that surgical resection timing
had twins). The weight was from 2600 to 4340 g., the length was from          is likely to be relevant to outcome. Seven additional high-quality studies
48 to 55 cm. Apgar scores were 8-10 (75%) and 7-8 (25%). Infants              involving 2.864 women have been most completely reported. While two
delivered in vertical position demonstrated 1.5 times less neurological       of these find no impact, six (75%) of these studies find that breast cancer
disorders and regained physiological weight loss 2 times faster. 100% of      outcome is affected by operative timing. A large number of retrospective
babies from the main group were breast fed compared to 71% delivered          studies of widely varying quality find no outcome difference as a
in regular position. A retrospective study of children from the main          function of resection timing.
group revealed a tendency towards outstripping in psychophysical              Conclusion: Although it is likely that the menstrual cycle phase of
development.                                                                  operation is relevant to outcome, the nature of the available data cannot
Conclusion: Patient’s evaluation of labors in vertical position, performed    allow a clear recommendation of precisely when to operate. It is,
with the help of a special questionnaire, demonstrated a positive attitude    therefore, concluded that current data are inadequate to recommend an
(decreased level of pain, shorter labor duration, earlier postpartum          immediate change in practice. Prospective studies of this potentially
rehabilitation) and bright emotional impressions.                             important question are essential.

P1.02.17                                                                      P1.03.02
CHILDBIRTH                                                                    REPRODUCTIVE ANAMNESIS. PROBLEMS AND
E. Fernandez, N. Soundararajan, Fernandez Maternity Hospital Pvt. Ltd.,       INTERRELATIONS
Hyderabad, Andhra Pradesh, India.                                             S. Lasachko, V. Chaika, V. Kvashenko, Dept. OB/GYN, State Medical
                                                                              University, Donetsk, Ukraine.
Objectives: To evaluate the effect of epidural analgesia on (a) the
incidence of obstetric interventions and (b) incidence of neonatal            Objectives: The wide spreading of steroid contraceptives is of great
jaundice.                                                                     concern for many specialists because of their influence on the
Study Methods: A retrospective cohort study of all our hospital               development of benign and malignant oncoma.
deliveries after January 1st, 1997. Group A: Women who received an            Study Methods: 157 women with breast cancer (I group), 206 with
epidural for vaginal/operative delivery.                                      benign fibrocystic disease (II group) and 250 healthy women (control
Group B: Women who went through labor/operative delivery without              group) were questionnaired.
epidural.                                                                     Results: The average age of questionnaired women was 53.7±1.4 years
The preliminary study includes 1050 women. Of these, 276 were in              old. Ratio of terminated pregnancies and deliveries in the I group was
Group A, 774 were in Group B. 146/276 in the epidural group were              3.1:1; in the II group – 2.7:1; in the control group – 1.4:1. 27.4% o f
primigravidae.                                                                women in I group had an abortion before the first labor; 22.6% in II
Results:                                                                      group; 11.3% in the control group. There were 33,4% nulliparous
a) There is a definite increase in incidence of forceps delivery in           women in I group; 27.3% in II group; 9.1% in the control group.
    primigravidae who received epidural analgesia (31.50% as opposed          11.7% of women in I group; 12.2% in II group and 15.2% in the control
    to 17.76%).                                                               group used steroid contraception for 5 years. 4.8% of women in I group;
                                                                              3.9% in II group and 5.2% in the control group used steroid
                                                                              contraception for more than 5 years.
MONDAY, SEPTEMBER 4                                                                                                                                  85

Conclusions: The absence of labor, abortions in anamnesis, especially if    (p=0.038), estradiol (p<0.001) and SHBG (p=0.001) levels. Elevation of
the first pregnancy was terminated, are factors of oncologic risk.          serum FSH concentration (p=0.0045) and a fall in prolactin levels
We didn’t reveal the dependence of benign and malignant oncoma              (p=0.0055) were observed.
development of lactiferous gland in using of steroid contraceptives.        Conclusions: We conclude that tamoxifen significantly reduced the
Pregnancy termination makes the greater risk than the use of steroid        proliferative activity of the mammary epithelium at the doses of 10 and
contraception. The content of estrogens and progestogenes in combined       20 mg/day.
oral contraceptives is decreased, new progestogene components are
used, increasing the safety of modern steroid contraception.
                                                                            BILATERAL BREAST CANCER IN THE HOSPITAL OF
P1.03.03                                                                    BARBASTRO (SPAIN).
COMPARISON OF ADJUVANT ENDOCRINE TREATMENT                                  C.Fuente, J.A.Pisón, R.Oncins, F.Lopez, J.A.Carrasquer, M.S.Matute,
(TAMOXIFEN AND GOSERELIN) VS. CHEMOTHERAPY (CMF)                            P.Gambó, A.Bitrian, J.Florian, M.Alonso, Dept. OB/GYN, Hospital of
IN PREMENOPAUSAL PATIENTS WITH HORMONE-                                     Barbastro, Huesca, Spain.
AUSTRIAN BREAST CANCER STUDY GROUP (ABCSG)                                  Objectives: The aim of the study was to evaluate Bilateral Breast Cancer
E. Kubista, M. Seifert, M. Gnant, R. Jakesz, on behalf of the Austrian      (BBC) in the area.
Breast Cancer Study Group, University of Vienna, Vienna, Austria.           Study-methods: A retrospective study was carried out during the period
                                                                            1989-99 and 19 cases were found. Epidemiological items, stage,
Objectives: In a prospective randomized trial premenopausal patients        synchrony, relapse-free survival and survival rates were reviewed.
were enrolled with estrogen and/or progesterone positive early breast       Results: BBC has a cumulative incidence of 0.27% in the area. The
cancers to investigate the efficacy of the combined endocrine treatment     majority of these lesions are metachronous (63.16%) versus synchronous
of Tamoxifen with Goserelin compared with 6 cycles of chemotherapy          (36.84%). The average time elapsed between the first and the second
using CMF.                                                                  cancer was 41.55+/-30.58 months for metachronous cases.
Study Methods: Starting in 1990 after radical operation, 1045 patients      The mean age at the diagnosis of the second cancer was 66.21+/-14.74,
were randomly allocated to CMF (day 1 and day 8) (C:600 mg/m2;;M:40         at menarchal was 11.37+/-1.71 and at menopausal was 49.95+/-4.24
mg/m2;F:600 mg/m2) or Tamoxifen (20 mg/day orally for 5 years) and          respectively. 31.58% had a first-degree relative with breast cancer.
Goserelin (3.6 mg, subcutaneously/every 4 weeks for 3 years). 51% of        21.05% had received high doss irradiation.
patients had T1 (<2cm) tumors, 54% were node negative.                      The first symptom was tumor in 94.74% cases of first cancer, however
Results: Within a follow-up period of 48 months, 167 patients showed        42.11% of second cancers were diagnosed by screening.
recurrences and 68 of the women died. Patients treated with endocrine       In first cancer we found 1 case at stage 0, 3 at I, 4 at IIA, 3 at IIB, 7 at
therapy showed a significantly improved recurrence-free survival (RFS)      IIIB and 1 at IV. In contralateral cancer we found 1 case at stage 0, 6 at
of 14% compared with 18% in the chemotherapy group (p<0.02). Local          I, 6 at IIA, 5 at IIB and 1 at IV.
recurrence rate for the patients with endocrine treatment was 3.9%          The one-year survival rate was 89.47% and at five 52.94%. The one-
compared with 7.1% in the CMF group. Overall survival showed no             year relapse-free survival rate was 73.68% and at five 35.29%. The
significant difference. Contralateral breast cancer and local recurrences   mortality rate was 52.63%.
were significantly less in the endocrine treatment group. In a              Conclusions: Perhaps due to efficient methods of detection the incidence
multivariate analysis age (0.0001), tumor stage (0.01), nodal stage         of BBC is higher in our area than other areas.
(0.0001) and therapy (0.02) were shown to be prognostic independent         The first cancer stage did not seem to be a risk factor. Contralateral
factors for recurrence free survival and for the overall survival tumor     breast cancer is often detected at an early stage.
stage (0.0003) and nodal stage (0.0001).
Conclusions: Data suggests that endocrine therapy is more effective in
the treatment of receptor positive premenopausal patients with early        P1.03.06
breast cancer compared to chemotherapy.                                     EVOLUTION OF INVASIVE TUMORS OF FEMALE GENITAL
                                                                            SYSTEM BETWEEN 1989 AND 1998 AT THE HOSPITAL OF
                                                                            BARBASTRO (SPAIN).
P1.03.04                                                                    R. Oncíns*, F. López-Sánchez, C. Fuente, J.A. Pisón, J. Pisón.
EVALUATION OF MONOCLONAL ANTIBODY MIB-1 IN THE                              *Pathology and Gynecology dep. of the Hospital of Barbastro, 22300
MAMMARY EPITHELIUM ADJACENT TO FIBROADENOMAS IN                             Barbastro (Spain).
J. A. Sousa, M. T. Seixas, G. Rodrigues de Lima, E. C. Baracat, L. H.       Objectives: To describe the status of invasive tumors of female genital
Gebrim, Dept. OB/GYN, Federal University of Sao Paulo, Sao Paulo,           system (ITFGS) in the population covered by the Hospital.
Brazil.                                                                     Study Methods: The Hospital of Barbastro covers a population of 50,220
                                                                            women being the only centre in the area. There were 182 cases of
Objectives: The study of the monoclonal antibody MIB-1 in the normal        ITFGS in the data of the Hospital Tumor Registry (HTR) for a 10-year
breast epithelium adjacent toe a fibroadenoma in women in the luteal        period (from 1989-1998). The distribution is the following, 16 cases of
phase of the menstrual cycle treated with tamoxifen at doses of 10 and      uterus-cervix (CIE 180), 89 uterus-corpus (CIE 182), 53 ovary (CIE
20mg for 22 days.                                                           183), 24 other genitals (CIE 184). The last group includes 23 cases from
Study Methods: The proliferate activity of the mammary epithelium           vulva and 1 from vagina. Epidemiological, clinical and pathological
adjacent to the fibroadenoma was studied by immunohistochemistry on         features were analysed.
the basis of the monoclonal antibody MIB-1 (IMMUNOTECH,                     Results: The mean age of the group was 63.07± 14.02, 62,75± 18,02
catalogue no. 0505, lot 001). The study was randomized and double           cervix, 64,47 ± 14 corpus, 57,06 ± 15,65 ovary, 72,56 ± 11,37 vulva
blind and was conducted on 44 women with fibroadenomas divided in to        and vagina case 23.
3 groups: A (N=16, placebo), B (N=15, tamoxifen, 10mg), and C (N=13,        The incidence had remained stabilised for the different locations in the
tamoxifen, 20mg). Tamoxifen was administered for 22 days starting on        10-year period. Metastatic disease at diagnosis was present in 12.5% of
the 2nd day of the menstrual cycle and a biopsy was taken on the 23rd       cervical cancers, 3.37% of corpus, 41.50% of ovary, 56.52% of vulva.
day. Serum extradiol, progesterone, sex hormone binding globulin            The most remarkable tumoral multiplicity was in corpus where a second
(SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH),       primary was found in 7.86% cases. Mortality of the group over the 10-
and prolactin were measured before treatment (21st and 24th day of the      year period was 41.75%, with 62.5% in cervix, 29.21% in corpus,
previous menstrual cycle) and on the day of biopsy.                         50.94% in ovary and 56.52% in vulva. Vaginal tumor case died in one
Results: The mean percentage of stained nuclei per 1000 cells was 9.2 in    month.
group A, 4.5 in group B, and 3.2 in group C. The Fisher test revealed       Conclusions: Epidemiological features of our data agree with Population
that tamoxifen significantly reduced the MIB-1 at the doses of 10 and 20    Cancer Registries in Spain. In addition, Local Regional Government
mg compared to the placebo group (P<0.0001), with no significant            mortality statistics also agree with our mortality data. As well as
differences between doses in terms of proliferative activity (p=0.21).      providing information for planning health resources of the hospital, it
Groups B and C presented a significant increase in progesterone             also serves to highligth.
86                                                                                                                      MONDAY, SEPTEMBER 4

P1.03.07                                                                      the group with benign lesions from the beginning, we observed 2 cases
EFFECT OF A HALF DOSE OF TAMOXIFEN ON PROLIFERATIVE                           of cancer, 1 of atypical proliferation.
J.R.M. Bernardes Jr., M.T. Seixas, G.R. de Lima, E.C. Baracat, L.H.
Gebrim, Dept. of Gynecology, Federal University of São Paulo, São             P1.03.09
Paulo, Brazil.                                                                GENOMIC ALTERATIONS PREDICT CLINICAL OUTCOME IN
                                                                              NODE-NEGATIVE DUCTAL BREAST CANCER
Objectives: To investigate the proliferative activity of the mammary          A. Dellas (1), J. Torhorst (2), H. Moch (2)
gland epithelium and plasma levels of progesterone, estradiol, prolactin,     Dept. OB/GYN, University Hospital, Basel, Switzerland.
luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex-         Institute of Pathology, University Hospital, Basel, Switzerland.
hormone-binding globulin (SHBG) in premenopausal women treated
with 10 and 20 mg of tamoxifen (TAM) for 22 days.                             Objectives: Development of genetic instability may play an essential
Study Methods: A randomized double-blind study was performed with             role in the progression of ductal breast cancer by accumulation of
43 premenopausal women with a diagnosis of fibroadenoma of the                genetic changes across the genome with some of these changes affecting
breast. The patients were divided into three groups: A (n=15, placebo);       critical genes.
B (n=15, TAM 10 mg/day) and C (n=13, 20 mg/day). They started                 Study Methods: Comparative genomic hybridization was applied to
taking an oral dose of TAM or placebo on the very first day of the            screen for DNA sequence gains and losses across all human
menstrual cycle. Lumpectomy was performed on the 22nd day of                  chromosomes in 20 tumors from node-negative ductal carcinomas with
therapy. Normal breast tissue samples were collected during surgery,          no disease recurrence and in 20 node-negative cases with recurrence
immediately immersed in 10% buffered formalin, processed for routine          after 10 years of follow-up. Axillary lymph nodes were re-assessed by
histology and immunohistochemistry for proliferating cell nuclear             immunohistochemistry in order to analyze the status of micro-
antigen (PCNA) detection. Two peripheral blood samples were                   metastasis.
collected, both on the 22nd day of the menstrual cycle, in order to           Results: The total number of genetic aberrations (copy number gains and
evaluate the hormone levels. PCNA expressing epithelial cells were            losses) per tumor was significantly associated with survival in the
quantified by using a digital program Kontron Image System KS-300 in          recurrence group (p<0.02). When copy number losses and gains were
1000 cells (400x).                                                            analyzed separately, only losses were significant (p<0.009). Of the
Results: The percentage of cells expressing PCNA was significantly            individual loci involved, losses of the chromosomes 11p (p<0.002) and
higher in the group receiving placebo (group A – 50.3%) when                  18q (p<0.004) were significantly associated with poor survival in the
compared to groups receiving TAM 10 or 20 mg/day (group B – 24.1%             recurrence group. No difference was observed in the detection rate of
and group C – 23.2%, respectively) (p<0.001). Differences between             micro-metastases between patients with and without recurrence.
groups B and C were not significant. Levels of progesterone, estradiol        Conclusions: This genome-wide analysis by CGH suggests that
and SHBG were significantly higher in B and C groups compared to              genetically advanced node-negative ductal breast cancers with a high
group A. Increasing concentrations of FSH (p<0.0045) and lower levels         overall number of genomic aberrations have a poor prognosis. DNA
of prolactin (p<0.0055) were only found in the group receiving 20             sequence losses of two specific regions, 11p and 18q, might be
mg/day of TAM (group C).                                                      associated with a more aggressive phenotype.
Conclusions: A 22-day TAM therapy, either with 10 or 20 mg/day,
significantly reduced the PCNA expression and therefore the
proliferative activity of the normal human breast tissue. Increasing levels   P1.03.10
of estradiol, progesterone and SHBG were associated with TAM therapy          BREAST CANCER DURING PREGNANCY: A STUDY OF 44
at 10 or 20 mg/day. However, a significant change of the level of FSH         CASES
and prolactin was reached only with a 20 mg/day dose.                         F. Gomez-Pastrana, Dept. OB/GYN, University Hospital La Paz,
                                                                              Madrid, Spain, M. Rua-Figueroa, Dept. OB/GYN, University Hospital
                                                                              La Paz, Madrid, Spain, A. Villasante, Dept. OB/GYN, University
P1.03.08                                                                      Hospital La Paz, Madrid, Spain, F. Calero, Dept. OB/GYN, University
HORMONE REPLACEMENT THERAPY (HRT) AND BREAST                                  Hospital La Paz, Madrid, Spain
Pereira, PAA; Fonseca, AM; Pasqualotto, EB; Bagnoli, VR; Penteado,            Objectives : The aim of the study was to investigate the influence of
SRL; Ramos, LO & Chnee, LH                                                    pregnancy on breast cancer prognosis.
Dept. OB/GYN, São Paulo University Medical School, São Paulo,                 Study Methods : Between 1966 and 1999, 44 pregnant women with
Brazil.                                                                       breast cancer were studied, 26 during pregnancy and 18 postpartum. The
                                                                              average age was 34 (27-46). 3 patients (7.5%) were primiparous and 38
Objective: The objective was to evaluate the prevalence of breast             (82.7%) had had previous pregnancies. Delay until diagnosis was 4
diseases in menopausal women submitted to hormone replacement                 months (0-24). 3 patients (7%) were in Stage I, 8 (16.6%) Stage IIA, 13
therapy (HRT).                                                                (30.2%) Stage IIB, 10 (23.3%) Stage IIIA, 4 (9.3%) Stage IIIB and 5
Methods: A total of 47 women who had abnormalities on mammography             (11.6%) Stage IV. 4 patients (9.3%) had inflammatory breast cancer.
during their follow-up were included in this retrospective study.             Diagnosis was made in 3 patients (6.8%) in the first trimester, 6 (13.6%)
Patients’ ages ranged from 41 to 70 years (mean age of 57,8 years).           in the second and 16 in the third trimester. In one patient the moment of
Patients were divided into 2 groups: Group I (n = 23) patients whose          diagnosis was unknown.
previous mammography was normal, and Group II (n = 24) patients               Results : The histological diagnosis was ductal infiltrating carcinoma in
whose previous mammography showed benign changes.                             79.6% tumors and intraductal carcinoma in 6.8% patients. 13 patients
Results: In group I we observed 9 cases of microcalcifications, 12 cases      (30%) had negative lymph nodes (pN0) and 26 (66.7%) positive (pN1).
of breast node, 1 case of spike lesion and 1 case of undetermined             3 cases that were diagnosed during the first trimester ended up on
mammography finding. No malignancies were found in this group. The            therapeutic abortion. At the moment of diagnosis 5 patients (11.4%) had
mean period of HRT administration in this group was 4,46 years. HRT           disseminated disease (M1). Global survival with 5.2 years follow-up was
discontinuation occurred in 6 cases. In group II we observed: a) 10           51.6%. Survival related to pN1 was 38.4% and 69% for pN0 (p<0.001).
patients had benign nodes beforehand with regression of the lesion in 3       The time free from disease was 31 months (1-192) and 9 patients
case, and no changes were found in 7 cases; b) 10 patients had initially      (27.7%) were disease free survivors. The more frequent metastatic
fibrocystic disease. One of them had breast cancer, 1 node with atypical      locations were bone, liver and lungs.
proliferation, 2 cases with sparse microcalcifications, 5 normal and 1        Conclusions : The accepted poor prognosis of breast cancer and
case with benign node; c) 2 patients had microcalcifications beforehand       pregnancy is related to the delay on diagnosis, more cases of pN1, and
without changes during the follow-up; d) 2 patients had spike nodes           because it occurs in young women. Therapeutic abortion does not seem
beforehand with the diagnosis of breast cancer in 1. In group II              to improve global survival.
discontinuation of treatment occurred in 7 cases and the mean period of
HRT was 4,4 years.
Conclusions: In the group that received HRT and had initial normal
mammography only benign findings were observed in the follow-up. In
MONDAY, SEPTEMBER 4                                                                                                                                     87

P1.03.11                                                                      regression modelling, that takes into account the effects of the other
SCINTIMAMMOGRAPHY (SMM) IN THE ASSESSMENT OF                                  variables as confounding factors, was used in the relative risk (RR)
BREAST CANCER AND AXILLARY LYMPH NODE                                         calculations.
METASTASES.COMPARATIVE STUDY WITH Tc-99m-MIBI AND                             Results: In the whole GM cohort, the risk of breast cancer was low
Tc-99m (V)DMSA.                                                               (SIR=0.55, 95% CI 0.52-0.58). The risk decreased significantly from 5-
This study is part of a CRP supported by IAEA                                 paras (ref.) to 8-paras (RR adjusted for the other variables 0.68, 95% CI
V.Papantoniou1, D.Lazaris3, J.Christodoulidou2, A.Stipsaneli1,                0.52-0.90). The increase in the age at first birth from less than 20 years
A.Louvrou3, E.Papadaki1, G.Pampouras2, A.Keramopoulos3,                       (ref.) to 30 years or more nearly doubled the risk (RR 1.83, 95% CI
S.Michalas3, C.Zerva1                                                         1.43-2.34). The increase in the birth interval had only a marginal
  Dpt. of Nuclear Medicine, 2Dpt of Radiology, 3Dpt.of Obstetrics &           independent effect on the RR. Parity was a significant risk determinant
Gynecology, «Alexandra» Hospital, University of Athens, Athens                only in ductal cancer, pregnancy interval only in lobular cancer, while
Greece.                                                                       the age at first birth did so in both histological subtypes. Advanced
                                                                              breast cancer of premenopausal GM-women appeared to be relatively
Objectives: The purpose of this study was to evaluate and compare the         independent on the present reproductive variables.
diagnostic accuracy of both tracers in the detection of primary breast        Conclusions: Parity, age at first birth and birth interval were significant
cancer and metastatic lymph node involvement and eventually minimize          and independent risk determinants in breast cancer of GM -women,
or clarify the cases of indeterminate mammographies (Mmx).                    especially on less advanced stages. Large number of full-term
Material and methods: 41 women (mean ±SD 61±13y) referred for a               pregnancies and young age at first birth were powerful risk reducers,
suspicious breast lesion on physical examination and/or an abnormal           whereas short birth interval was relatively weak in this respect.
Mmx underwent MIBI & (V)DMSA SMM at separate sessions.Lateral                 Reproductive risk variables appeared to have divergent effects on
prone and anterior supine images were obtained after administration of        different histological subtypes.
740-925 MBq of each tracer, at 10 & 60 min postinjection. In the field
of view the ipsilateral axillary region was also included. SMM and Mmx
were compared with biopsies.                                                  P1.03.13
Results: Breast cancer of 5 different types was histologically confirmed      BREAST PARENCHYMA THICKNESS ULTRASOUND
in 26 patients: Tumor size ranged from 0,7-6cm (mean ± SD:                    MEASUREMENT (PBI: PARENCHYMAL BREAST INDEX) AND
2,02±0,94). Benign lesions were found in 15 patients with mean size           ITS CORRELATIONS WITH BBD (BENIGN BREAST DISEASE).
2,05±2,6 cm (range 1-10,5 cm). Mmx was definitely positive in 21/26           M. Angiolucci, Dept. OB/GYN, University of Cagliari, Italy
patients with breast cancer and indeterminate in 5/26 (sensitivity 80,7%).    M.P. Gennamari, Dept. OB/GYN, University of Cagliari, Italy
In benign lesions Mmx was true negative in 5/15 cases and                     S. Guerriero, Dept. OB/GYN, University of Cagliari, Italy
indeterminate in 8/15 (specificity:33,3%).MIBI and (V)DMSA SMM                G.B. Melis, Dept. OB/GYN, University of Cagliari, Italy
achieved to recognize 23/26 breast cancer (sensitivity: 88,4%) and were
true negative in 14/15 (specificity:93,3%). Tumor/Background (T/B)            Objectives: To demonstrate if there is a relationship between
ratio for breast cancer benign lesion and contralateral normal breast         parenchimal breast thickness and BBD.
(CNB) was:                                                                    Study methods: We performed breast US (ultrasound) in 557 women.
  T/B                Tc-99m-MIBI               Tc-99m (v)DMSA                 One group included US pattern of normality. Another group included
                     10 min        60 min      10 min         60 min          women with diffuse, bilateral BBD, with no focal lesions (according to
  Cancer             1,89±0,83 1,90±0,82 1,82±0,7             1,80±0,69       ANDI classification: see Hughes and Mansel, the Lancet 5/12/87). PBI
  Benign lesions 1,11±0,11 1,21±0,21 1,20±0,22                1,31±0,3        was calculated measuring parenchymal breast thickness in 8 radial
  CNB                1,12±0,1      1,14±0,13 1,13±0,15        1,14±0,20       scans, disposing the probe along the bisectrix of the four breast
                                                                              quadrants (both right and left) and finally summing these 8 values. Data
MIBI diagnosed correctly 12/13 and (V)DMSA 11/13 indeterminate
                                                                              were analyzed by Student “t” test and analysis of variance for not
                                                                              coupled data. Values of p<0.05 were considered significant. We also
(V)DMSA detected moreover 9/10 and MIBI 4/10 ductal carcinomas in
                                                                              studied diagnostic value of some PBI’s values cut-off in assessing the
situ. (V)DSMA was also diffusely concentrated in benign lesions
                                                                              presence of BBD. Finally, we evaluated within-operator and among
complicated with hepitheliosis. Metastatic lymph node involvement was
                                                                              operators variability in performing the examination.
successfully imaged in 16/19 patients with metastatic disease
                                                                              Results: There were significant PBI value differences in women with
(sensitivity: 84,2%), by both agents, while true negative scans were
                                                                              BBD in comparison with normal women. PBI was significantly higher in
observed in 19/22 (specificity: 86,3%) patients with benign or malignant
                                                                              women with BBD than in women with normal US pattern. Among the
tumors without lymph node metastases.
                                                                              different kinds of BBD, fibrous dysplasia was associated with PBI
Conclusion: MIBI as well as (V)DMSA showed an excellent ability in
                                                                              values lower than those we observed in other BBD (adenosis, cystic
detecting breast cancer and its lymph node metastases. (V)DMSA had
                                                                              dysplasia, and so on).
also the tendency to be localized diffusely and more intensely than
                                                                              Conclusions: PBI is an interesting tool in monitoring the breast
MIBI, in benign or precancerous alterations which are at risk to develop
                                                                              conditions in subjects with BBD. The possible use of PBI in patients
malignancies and could provide a useful tool in their diagnosis and
                                                                              submitted to hormonal therapy will be also discussed.
treatment. Finally, we believe that both tracers could offer an alternative
in discriminating non-diagnostic Mmx.
                                                                              REFERRED ANALYSIS OF AN OUTPATIENT BREAST CLINIC
                                                                              PERFORMANCE WOMEN
                                                                              José Tadeu Vicelli, L.C. Zeferino, M.S.C. Gurgel, J.E. Ferro. Unicamp,
M.Hinkula, A.Kauppila, Dept.OB/GYN, University Hospital, Oulu,
                                                                              Oncologia Ginecológica, Rua Alexander Fleming, 101, Barão Geraldo,
Finland E.Pukkala, P.Kyyrönen, Finnish Cancer Registry, Helsinki,
                                                                              Campinas, Brazil, 13083-970.
                                                                              Objectives: To evaluate the specificity and sensitivity of clinical
Objectives: The aim of this national cohort study was to assess the
                                                                              examination of breast diagnosing the performance of outpatient breast
significance of parity, age at first birth, birth interval and age at
                                                                              clinic assisting 35-49 year women referred breast cancer control
diagnosis to the risk of breast cancer of grand multiparous (GM= at least
                                                                              programmes performed in primary health community centers in
five full-term pregnancies) women, by histological subtype and clinical
                                                                              Campinas, Brazil.
presentation of malignancy.
                                                                              Study Methods: This was a decriptive and diagnostic test validation
Study Methods: The Population Register of Finland with complete
                                                                              study, that included seven hundred twelve (712) women referred the
family information since 1974 included about 90, 000 GM women. This
                                                                              outpatient clinic due to clinical symptoms and/or abnormal breast
data was linked with that of Finnish Cancer Registry. During a follow-
                                                                              clinical examination, according to physician evaluation. Mammography
up of about 2 million person-years, 1,508 breast cancers were obtained.
                                                                              was available only in the outpatient clinic.
Standardized incidence ratios (SIR) were calculated by dividing the
                                                                              Results: Six hundred and sixty one (661) symptomatic women and five
number of observed cases by the number of expected cancers. Poisson
                                                                              eighty four (584) women with abnormal clinical examinations were
88                                                                                                                       MONDAY, SEPTEMBER 4

studied. Mass or thickening were the most frequent symptoms (65%).            25 cases of cervical carcinoma to explore the relationship between
Four hundred and thirty six (436) surgical byopsies or cytologic              cyclins D1 and E and cervical cancer.
procedures were performed. One hundred sixty four (164) carcinomas            Results: We found cyclin D1 expression showed down-regulated
were diagnosed after the first consultation and four carcinomas during        expression in cervical cancer but cyclin E was increased in cancer group.
the follow-up. The positive preditive values of clinical examination and      Other clinicopathological prognostic factors were not correlated with
mammography were respectively, 82,3% and 82,4%. The sensitivity               cyclins D1 and E expression.
values of clinical examination were 80,3% and 83,3%.                          Conclusions: Our results were consistent with the concept that the cyclin
Stages I, II, III and IV were found in 13,9%, 60,8%, 15,1% and 10,2%.         E overexpression may play an important role in neoplastic
Conclusions: The breast cancer control programme for 35-49 year old           transformation of the cervix. However, further, study based on larger
women based on symptoms and clinical examination can be considered            numbers of cases with correlation of cyclins D1 and E status and
effective to promote early diagnosis without using mammography                survival data will be needed to elucidate the use of cyclin expressions as
examination at primary health care level. For these women,                    prognostic factor.
mammography secondary level shows high Positive Preditive and
Sensitivity values.
                                                                              EOSINOPHILIC STROMAL INFILTRATION IN CARCINOMA OF
P1.03.15                                                                      THE UTERINE CERVIX
MATCHED PAIR ANALYSIS OF SURVIVAL AFTER LOCAL                                 M.L. Fenández-Pérez, J. Lombardía, J. Potenciano, M. Sanchez-Dehesa,
RECURRENCE IN BREAST CANCER PATIENTS AFTER                                    J. Porro, A. Sánchez-Dehesa, Gynecology Oncology Unit, Dept.
MASTECTOMY VS. BREAST CONSERVATION: A LONG-TERM                               OB/GYN, Hospital Virgen de la Salud, Toledo, Spain.
W. Janni, Th. Dimpfl, L. Starflinger; D. Rjosk, F. Bergauer, W. Sigg, H.      Mortality from carcinoma of the uterine cervix used to be the highest
Sommer, Th. Genz. I. Universitaetsfrauenklinik, Klinikum Innenstadt,          with the ovarian carcinoma among all gynecological cancer, and the
Munich, Germany                                                               most effective way to reduce mortality seemed to be the screening for
                                                                              cervical cancer.
Objectives: Local recurrence remains a major concern after primary            A case of eosinophilic stromal infiltration in carcinoma of the uterine
treatment of breast cancer, with a major impact on subsequent survival.       cervix in a 33-year-old woman is reported.
While most studies report a poorer survival in patients with a local          The symptoms were: abnormal bleeding after sexual relations and
recurrence after mastectomy than after breast conservation, it remains        abdominal pain.
controversial, whether different risk profiles at time of primary diagnosis   The exploration was normal except an irregular and bleeding lesion in
may account for this difference.                                              posterior labia ± 3 cm.
Study Methods: Matched pair analysis of 134 patients with newly               After a positive cytology (squamous carcinoma), the colposcopy and the
diagnosed locoregional recurrence of breast cancer without evidence of        biopsy complemented the diagnosis of the uterine cervix carcinoma. The
systemic disease. Patients were matched for equivalence in primary            rest of the explorations were normal.
surgical treatment, tumor size, nodal status and age. The significance of     The surgical treatment (radical hysterectomy) was made 15 days later;
various prognostic parameters at time of primary diagnosis and at time        the histopathological study was: two cervix cancer lesions circunscribed
of recurrence were evaluated in respect to survival after recurrence by       of 4.5 and 14 mm, with eosinophilic stromal infiltration, locating in the
univariate and multivariate analyses (median follow-up 8.4 years).            uterine cervix. The rest of the histopathologic analyzing was normal
Results: Primary risk factors were comparable between both groups, but        (including the nodes). The FIGO stage was IB.
local recurrence occurred on an average of 9 months earlier in patients       Three years later, the patient is out of illness.
after mastectomy (P = .08). While univariate analysis demonstrated            This class of cervical cancer with stromal eosinophilia has a positive
primary lymph node status (P = .0001) and disease free interval from          correlation between the quantity of the stromal eosinophilia reaction and
primary treatment to local recurrence (P = .0002) to be the most              survival rate. These patients tend to have early stage disease and are
significant prognostic factors for survival after local recurrence, primary   younger than the patients lacking this intense eosinophilic infiltration.
surgical treatment was of marginal influence (P = .05). Multivariate          But, if the malignant disease is associated with peripheral eosinophilic, it
analysis confirmed the potential significance of these prognostic factors,    is a marker of extensive disease and is associated with poor prognosis.
however demonstrated the combination of disease free interval and
primary surgical treatment to be the most significant, independent risk
factor for cancer related death (P = .0001).                                  P1.04.03
Conclusions: Local recurrence after mastectomy for primary breast             SYNCHRONOUS CERVICAL CANCER
cancer is followed by a marginally poorer outcome, which probably can         M.A. García-Largo Seseña, M. L. Fernández-Pérez, J. Lombardía, M.V.
be mainly attributed to a shorter disease free interval.                      Peral, J. Porro, A. Sanchez-Dehesa, Gynecology Oncology Unit, Dept.
                                                                              OB/GYN, Hospital Virgen de la Salud, Toledo, Spain.

P1.04 CERVIX                                                                  Although it seems to increase in the incidence of adenocarcinoma of
                                                                              uterine cervix, the cervical adenocarcinoma concomitant with squamous
P1.04.01                                                                      cell neoplasm is not a common lesion.
EFFECT OF G1 CYCLINS EXPRESSON ON CLINICAL                                    A case of synchronous malignant neoplasm of cervix in a 62-year-old
PROGNOSTIC PARAMETERS IN CERVICAL CANCER                                      woman is reported: a primary adenocarcinoma coexisting with
J.W. Kim, Y.T. Kim, E.K. Choi, E.M. Cho, Dept. OB/GYN, Yonsei                 squamous cell carcinoma in uterine cervix.
Univeristy College of Medicine, Seoul, Korea                                  The symptom was abnormal vaginal bleeding one year ago and the
                                                                              exploration was normal, except a small ulcerosus and bleeding polypous
Objectives: Alterations in the expression of genes that control the cell      in the anterior cervical labia.
cycle may be of critical importance in tumorigenesis and malignant            The surgical treatment (radical hysterectomy) was complemented with
transformation. The major regulatory events leadin to cell proliferation      radiotherapy (external radiation and brachytherapy).
occur in G1 phase of cell cycle, and the deregulated expression of G1         The histopathological study was: squamous cell carcinome (SCC) G1IB
cyclins is related to oncogenesis. Cyclins D1 and E play important roles      and an endometroid adenocarcinoma G1IB.
in the progression of cell through G1 phase of the cell cycle.                One year and nine months later, the patient is well.
Amplification and/or overexpression of the cyclin D1 gene and aberrant
expression of cyclin E has been described in various forms of human
cancer. However, the role of cyclins D1 and E in cervical cancer has
been poorly defined.
Study Methods: In this study, we examined the expression of cyclins D1
and E by Northern blot technique and by the status of human
papillomavirus (HPV) type 16 and 18 by polymerase chain reaction in
MONDAY, SEPTEMBER 4                                                                                                                                      89

P1.04.04                                                                      Study Methods: The attempt colour dopplerometry for revealing features
ELECTROSURGICAL EXCISION COMBINED WITH LASER                                  blood flow in cervix of a uterus is carried out at endometryos (48
VAPORIZATION OF CERVICAL LESIONS EXTENDED TO                                  patients), chronic inflammatory process (25) and at 13 patients without a
VAGINA                                                                        pathology cervix of a uterus.
C.A. Panzeri, N.E. Dicuatro, Universidad Nacional de Córdoba,                 Results: An estimation of blood supply carried out on a parameter
Córdoba, Argentina.                                                           systolo-diastolic ratio (S/D) of an arteria vaginalis at a level of an
                                                                              average third of a cervix uterus and arteria uterina at a level of internal
Objectives: On extensive intraepithelial cervical lesions of any grade        fauces.
including the endocervix until 10 mm to make a wide excision by loop          Fixed at a physiological condition, the parameter cervix has peer
diathermy (the transformed zone and the internal area of the lesions) and     meaning from the right and left party cervix. Systolo-diastolic parity of
removing the marginal areas by Laser vaporization.                            an arteria uterina authentically is higher than in branches of an arterias
Study Methods: 107 patients (85% nulliparus, younger than 25 years            vaginalis. At endometryos and chronic inflammatory process and is
old), the mean age of the patients was 20 (range 18 to 63), having SIL-       determined asymmetric in parameters S/D in arterias vaginalis and the
High and persistent Low Grade located widely on the ectocervix but also       high meanings S/D in arterias uterina are enlarged.
extends to one or more “cul de sac”. The diagnosis was made with exo          Conclusions: Thus it is expedient to use the offered parameters blood
and endocervical cytology, colposcopy and ECC. When the endocervical          flow as additional diagnostic criteria at an estimation of a condition of a
canal was comprometed a conization with microneedle or great                  cervix uterus.
triangular loop, eradicating 20 mm maximun of the canal, followed by
5mm of vaporization of the affected area including the 10mm of
peripheral borders with normal aspect. This group comprising has been         P1.04.07
treated between July 1993 to July 1999.                                       UROGENITAL INFECTIONS AND PATHOLOGY OF THE CERVIX
Results: Followed by 22 month (6-40), the results with one procedure          UTERI
cured 104/107 – 97.20% - the samples were adequate for histological           V. K. Chaika, V. A. Kaverina, B. A. Iotenko, Donetsk State Regional
evaluation, positive peripheral margins were present, but without vertex      Center of Maternity and Child Protection, Donetsk, Ukraine
compromise. The follow up of the ones with lateral compromise can be
assessed without treatment. With visible Squamous Columnar Junction           At the present time, Chlamydia trachomatis is first among infections
in 105:107, without complications or cervix scarring. The recidives were      affecting the cervical canal and leading to the development of the
treated immediately.                                                          inflammation of the mucus of the cervix uteri. Chlamydious cervicitis is
Conclusions: This procedure is a behavior preferable to protect women’s       characterised by asymptomatic clinical course and this often makes it
fertility, especially young and nulliparus. Constitutes great valor method,   difficult to diagnose, promotes the spreading of the ascending infection
in an outpatient setting under local anesthetic.                              and cause endometritis and salpingitis B.
                                                                              Study Methods: To determine Chlamydia trachomatis we applied
                                                                              straight immunofluorescence immunofermental analysis (IFA).
P1.04.05                                                                      Nesisseria Gonorrhoeae prefer cylindrical epithelium. Clinical
MAGNIFIED CHEMILUMINESCENT EXAMINATION (MCE) IN                               symptoms are rather specific, laboratory diagnosis is not difficult. Viral
DETECTION OF CERVICAL NEOPLASIA - NEW DIAGNOSTIC                              infections promote the development of cervitis, background diseases of
MODALITY                                                                      the cervix uteri. Persistence of the latent viral infection can lead to server
Agarwal N, Suneja S, Mahishee, Mishra K, Deptt of Obstetrics &                dysplasia and invasive cancer of the cervix uteri. We carried out the
Gynaecology and Pathology, UCMS & GTB Hospital, Delhi, India                  investigation. Two hundred patients were observed. All of them had
                                                                              UGI and their history includes pathologic changes of the cervix uteri.
Objectives: The present study has utilised chemiluminiscent illumination      The changes of the cervix uteri were revealed in 146 persons (73%). Of
and compared with routine projected incandescent light (PIL). MCE was         them cervitis in 98 persons (67%), ectopia cylindrical epithelium 33
also evaluated as an adjunct to Papanicolaou smear. Study Methods: A          persons (22%), dysplasia of the cervix uteri 15 persons (11%).
total of 120 patients with an unhealthy cervix entered the study protocol     Chlamidia is was 43%, mixed chlamidia-viral infections 38%, the virus
and were evaluated with MCE and Pap smear examination under PIL               of the simple herpes 11%.
using 5x magnification and colposcopy.                                        Conclusions: In the pathology of the cervix uteri it is necessary to
Results: 20 out of 120 patients showed histopathological evidence of          examine the cervical mucus for pathogenic flora, scraping of the cervical
various grades of cervical neoplasia on directed biopsy. Detection of         epithelium for the presence of urogenital chlamidiosis. The bacteriologic
cervical neoplasia was significantly superior by MCE (18/20) as               and scopic examination of the vaginal discharges, the blood analysis for
compared to PIL examination (11/20) (p < 0.05). PIL produces reflective       the presence of specific antitoies to the virus of simple herpes and viral
glare inhibiting discrimination of acetowhite lesions from normal             antigen, etiotropic treatment and according to the indications, aiming
epithelium. Placement of blue filter id not improve visualization.            biopcy was carried out.
Identification of acetowhite areas with speculoscopy is a function of
chemiluminescence and not of light coloration. Combining MCE with
Pap smear (Pap-Spec test) could detect 19/20 lesions compared to 15/20        P1.04.08
for Pap smear alone. Pap-Spec is specially helpful in detecting lower         DO WE NEED TO SCREEN FOR CERVICAL CANCER IN UNITED
grades of cevical lesions. Patients with negative Pap-Spec were               ARAB EMIRATES?
extremely unlikely to harbor significant pathology.                           S.Ghazal-Aswad, P.Badrinath, Faculty of Medicine & Health Sciences,
Conclusions: Speculoscopy of acetowashed cervix is a new method for           UAE University, P O Box 17666, Al-Ain, United Arab Emirates.
detection of cervical neoplasia. Chemiluminescent light is a blue-white
chemical light which emits no thermal or electrical energy, is non-toxic      The Objectives: To find the prevalence of the pre-cancer and cancer of
to tissues and does not produce glare. It is superior to PIL examination      cervix in UAE and to study the feasibility of instituting a widespread
and combining it with Pap smear can contribute to better detection of         screening program.
cervical neoplasia.                                                           Study Methods: The first part was a Retrospective Pilot study to review
                                                                              the incidence of pre-malignant and malignant conditions of the cervix in
                                                                              smears taken in two hospitals (opportunistic screening), the result of this
P1.04.06                                                                      study was used to plan an ongoing prospective epidemiological study.
FEATURES DOPPLEROMETRY IN WOMEN WITH A                                        Results: 2000 recent cervical smear results from two different hospitals
PATHOLOGY CERVIX OF THE UTERUS                                                in Al-Ain District were analysed. The overall incidence of abnormal
N. V. Dub, L. I. Titchenko, M. A. Chechneva, E. A. Alekseeva, Moscow          smear was 3.15%. The incidence of abnormal smear in the first hospital
Regional Research Institute of Obstetrics and Gynecology, Moscow,             which serve mainly UAE nationals was 1.7% compared to 4.6% in the
Russia                                                                        second hospital which serve the non-nationals (P-value >0.001 and Chi-
                                                                              squares 13.78). Based on the above prevalence of about 3%, a
Objectives: The aim of the study was to attempt a color dopplerometry         representative sample of 4500 is planned to detect the prevalence with a
for revealing features of blood flow in the cervix of a uterus.               precision of 0.5% and 95% confidence. An epidemiological study is on-
                                                                              going in different emirates and the samples are distributed according to
90                                                                                                                    MONDAY, SEPTEMBER 4

the proportion of population in each district (2/3rd are selected from      P1.05 CONTRACEPTION
primary health centres and 1/3rd from secondary care institutions).
Conclusions: Analysis of the first 1400 smears suggested an incidence of    P1.05.01
2.8% of cervical pre-cancer abnormalities. No cancer cases were seen.       USE OF HORMONAL CONTRACEPTION BY DIFFUSE BENIGN
The final result of this study will be discussed in the meeting.            FIBROCYSTIC DISEASE
                                                                            V.P. Kvashenko, S.A Lasachko, G.M. Adamova, State Medical
                                                                            University, Il’yicha, Donetsk, Ukraine.
DIAGNOSTIC VALUE AND EFFECTIVNESS OF LOOP                                   Objective: The aim of the investigation is to study the influence of
DIATHERMY IN TREATMENT OF CIN LESIONS                                       different kinds of hormonal contraceptives on hormonal background and
Pantovic S, Petkovic S, Kesic V, Argirovic R, Milenkovic V, Mirkovic        the course of fibrocystic disease, to determine more acceptable kinds of
Lj, Vukajlovic S, Radovic M., Department of Gynecology and                  hormonal contraceptives for these patients.
Obstetrics, Clinical center of Serbia, Belgrade, Yugoslavia                 Study Methods: 163 women aged 19 – 38 with fibrocystic disease were
                                                                            examined. Patients were divided into three groups:
Objectives: Premalignant changes of uterine cervix develop in the           I group – 60 women with fibrocystic disease, they didn’t use hormonal
reproductive period of women aged 15-50. The incidence of these             contraceptives;
changes used to be low, but nowadays it reaches 70/1000 in sexually         II group – 52 women using monophase combined contraceptives;
active women below the age of 20.                                           III group – 51 women pure gestogene.
Study methods: In order to investigate advantages and disadvantages and     The content of estradiol, progesterone, prolactin in blood serum before
to analyze the efficacy of diathermy in treatment of premalignant           contraception was defined in dynamics.
changes on the uterine cervix, we compared the results obtained in 178      Results: Improvement of the disease took place in 10.0% of the I group,
patients treated by LLETZ method and 100 subjected to conventional          in 26.9% of the II group, in 51.0% in the III group. Stabilization of the
surgery.                                                                    process was in 80.0%, 69.3%, 47.0% accordingly, aggravation – in
Results: Histopathology after biopsy and LOOP diathermy coincided in        10.0%, 3.8%, 2.0% accordingly. There were no cases of malignisation.
69.1%. The findings obtained with biopsy and after LOOP diathermy           In the second group, galactorrhea symptoms increased in 14.3%.
coincided in 19.0% of cases with benign changes and 68.2% of CIN III        The direct correlating dependence between the degree of disease
changes.                                                                    expression and estradiol/progesterone quotient was revealed, correlation
The best results were obtained in cases of HPV infection and CIN I          quotient was 0.41%.
89.7% and 78.8% of our patients. Significant difference was found           Before contraception hormone content in the three groups didn’t differ.
between distribution of corresponding histopathological results obtained    For two years in the third group decreasing of estradiol and prolactin,
by biopsy on one hand and postoperative results obtained by LOOP            increasing of preogesterone levels was marked.
diathermy and conisation on the other. Diathermy yielded corresponding      In the second group decreasing of estradiol, increasing of progesterone
results in 69.1% and conisation in 52.8% of our patients.                   and prolactin levels was marked.
Conclusions: LLETZ (LOOP) is an effective method in treatment of            In the first group, no change in hormone levels was marked.
cervical dysplasia. The advantages include simple and short procedure,      Conclusion: Hormonal contraceptives show positive influence on
possible for outpatient¢s treatment in local anesthesia, shorter            mammary glands by fibrocystic disease. Pure gestogene must be chosen,
hospitalization, and improved quality of sample obtained for                if there are galactorrhea symptoms.
histopathologic examination and substantially lower cost of the
                                                                            MEASURE AND COMPARE THE USE AND EFFECTIVENESS OF
P1.04.10                                                                    IRANIAN AND FOREIGN TYPES OF IUDs
DETECTION OF HUMAN PAPILLOMAVIRUSES IN                                      S. Taavoni, Iran University of Medical Sciences, Tehran, Iran
B.Stanimirovic1, N. Kuljic-Kapulica2, R. Radosavljevic1,                    This is a field study. The purpose was to measure and compare the use
V. Stanimirovic3, N. Antic1, V. Rajkovic1                                   and effectiveness of different types of Iranian IUDs (cooper 7 – Tcu200-
  GYN/OB Clinic “Narodni front”, Belgrade; 2 Institute of Virology,         ML) and foreign types of IUDs (LOOP, B, C, D – cooper 7, T cu200,
Military Medical Academy, Belgrade; 3 Galenika R&D Institute,               T380A – ML375) in 1,620 women who have been using the
Belgrade                                                                    aforementioned methods for birth control in the family planning clinics
                                                                            of Iran Medical Sciences University in 1994. Poisson statistical selection
Objectives: In the 1994-1998 period 1000 patients suffering from            was used.
cervical squamous intraepithelial lesions (SIL) were checked for the        With attention to the goals of research, the tool used was a checklist
presence of Human Papillomavirus (HPV) infection. Nowadays, it has          composed of three main parts – personal characteristics, type of IUD and
been fully acknowledged that certain types of these viruses play a key      IUD complications. To analyze the information, the descriptive statistics
role in the onset and evolution of these diseases.                          and life table were used.
Study Methods: The methods used in the study included cytodiagnostic        The results of this research shows that the use and effectiveness of each
methods, colposcopy, histopathological examination of cervical              Iranian and foreign IUD after a period of 1 – 11.5 years is different and
specimens and HPV typing of cervical swabs using commercial kits.           is relatively higher than in the reports declared by other countries.
Results: The investigation showed that SIL of the cervix occurred in        Finally, suggestions on the base of gained data for the use of information
very young women. The highest incidence was found in age groups 24          and the following research were made.
–28 years (21.2%) and 29-33 years (19.1%). Therefore, over 40% of the
entire study group was under 34 years of age. Histological analysis of
tissue specimens showed that 79.3% of patients had lesions of low           P1.05.03
histological grade (LSIL), while in 20.7% the disease progressed to a       EFFECTS OF LOW-DOSE ORAL CONTRACEPTIVES ON LIPID
high histological grade (HSIL).                                             METABOLISM IN WOMEN WITH INSULIN-DEPENDENT
Detection of Human Papillomavirus infection rendered negative results       DIABETES MELLITUS
in 34.9% of patients, 17.8% were 6/11 positive (non-oncogenic type)         S. Nikitine, O. Lantseva, V. Potin
and in 47.3% oncogenic types were found (16, 18, 31, 33). This finding      Department of Endocrinology, Ott Institute of OB/GYN RAMS, St.
in the LSIL group was of extreme significance since it influenced the       Petersburg, RUSSIA
treatment approach. Oncogenic types of viruses were detected in 34.3%
of LSIL, which indicates a high progression potential of the pathological   Objectives: The modern progestins and reduction of steroid dose in
changes.                                                                    combined oral contraceptives (OCs) has led to the minimising of adverse
Conclusions: The study showed a high incidence of HPV infection in          effects on metabolism. The aim of the study was to evaluate the effects
cervical SIL as well as its significance in the onset and evolution of      of OCs on glycometabolic control and lipid metabolism in women with
these changes. Detection of oncogenic HPV types in LSIL was crucial in      insulin-dependent diabetes mellitus (IDDM).
deciding on the treatment approach.
MONDAY, SEPTEMBER 4                                                                                                                                     91

Study Methods: The group A (10 IDDM women with the mean age                    P1.05.05
27,2±1,3 years and the mean duration of diabetes 11,6±2,1 years) used a        EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOL
combination of 0,02 mg ethinylestradiol (EE) and 0,15 mg desogestrel           /LEVONORGESTREL ORAL CONTRACEPTIVES ON
(DSG) (“Mersilon”, Organon). The group B (10 IDDM women with the               HEMOSTATIC BALANCE
mean age 30,2±1,6 years and the mean duration of diabetes 11,3±1,7             U.H. Winkler1, G. Petersen2, E. Schulte-Wintrop2, A.T. Teichmann3
years) used a combination of 0,03 mg EE/0,15 mg DSG (“Marvelon”,                 Dept. OB/GYN, Friedrich-Ebert-Hospital, Neumünster, Germany
Organon). All patients were treated with insulin, were normotensive, had         Wyeth-Pharma, Schleebrüggenkamp 15, D-48159 Muenster, Germany
good kidney function. Evaluation was performed before and after 3, 6              Women's Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg,
months of hormonal intake.                                                     Germany
Results: The mean HbA1c values were similar at the beginning, after 3
and 6 months of the study in the two groups. There was no statistically        Objectives: Levonorgestrel (LNG) is a well-established progestin
significant change in the insulin requirement of the hormonal intake. In       frequently used in oral contraceptives (OC). In a controlled clinical trial,
the group A increased levels of apolipoprotein-A1 (apo-A1) were noted          the long-term effects of two low-dose OC with different doses of both
in the end of the study (from 1,7±0,1 g/l to 2,2±0,1 g/l, p<0,05). In the      LNG and ethinylestradiol (EE) on hemostatic balance were studied.
group B decreased levels of fasting total cholesterol after 3 months of        Study Methods: In a doubleblind, randomized, parallel-group, study 67
OCs use (from 7,68±0,45 mmol/l to 6,34±0,55 g/l, p<0,05), VLDL-C               healthy women aged 18 to 35 years received for 12 cycles either Leiosâ
after 3 and 6 months of OCs use (from 0,98±0,09 mmol/l to 0,7±0,09 g/l         (0.02 mg EE/0.1 mg LNG, n=34), or Stediril 30â (0.03 mg EE/ 0.15 mg
and 0,7±0,04 mmol/l, p<0,05; respectively) and triglycerides after 6           LNG, n=33). Blood samples were taken before treatment and at day 17-
months of OCs use (from 2,15±0,1 mmol/l to 1,5±0,1 g/l, p<0,001).              21 of cycle 3, 6, and 12. Relevant parameters of the hemostatic system
Conclusions: The use a combination of 0,02 mg EE/0,15 mg DSG and               were analyzed.
0,03 mg EE/0,15 mg DSG is associated with antiatherogenic lipoprotein          Results: Changes of the hemostatic parameters were seen after 3
profile. These effects can be particularly important from the                  treatment cycles, but not after 6 or 12 cycles. No significant differences
therapeutical point of view in IDDM women with hyperlipidemia                  between the treatment groups were observed. In both groups the anti-
disorders.                                                                     coagulatory parameters Antithrombin III and Protein C activity
                                                                               increased whereas free Protein S slightly decreased. The pro-coagulatory
                                                                               parameters Fibrinogen, Factor VII, and Fragment 1+2 showed a
P1.05.04                                                                       moderate increase. No changes of the von Willebrand factor were
PRIMARY CARE AUDIT ON INJECTABLE CONTRACEPTIVE,                                detected. In addition, the fibrinolytic parameters D-dimer-fibrin
MEDROXYPROGESTERONE ACETATE (DEPO-PROVERA) & ITS                               degradation product and the Plasmin-antiplasmin complex increased
LONG TERM EFFECT ON SERUM OESTRADIOL LEVEL & BONE                              whereas the Plasmin activator-inibitor decreased moderately.
DENSITY                                                                        Conclusions: Both LNG/ EE formulations Leiosâ and Stediril 30â have
S.P. Singh, Lordswood Health Center, Chatham, Kent, UK.                        only small and well balanced effects on the hemostatic system.

Objective: This audit was carried out to study the long term effect of
injecting Depo-Provera, an extremely effective contraceptive with              P1.05.06
relatively poor continuation rate due to its side effects in spite of          EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOL/LEVO-
thorough counseling as only 31% have continued for over 3 years. The           NORGESTREL ORAL CONTRACEPTIVES ON SERUM LIPIDS
majority stopped after 9-18 months, which was alarming so we decided           W. März1, G. Petersen2, E. Quentin2, A.T. Teichmann3, H. Wieland1
to explore the reasons for discontinuation.                                      University Hospital, Hugstetter Str. 55, 79106 Freiburg, Germany
Study Methods: I have given this injection to 147 patients between               Wyeth-Pharma, Schleebrüggenkamp 15, D-48159 Muenster, Germany
January 1994 – December 1999, between the ages of 15-51 years (mean               Women's Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg,
33). Patients given the injection were searched through computer               Germany
records, notes, and follow-up card. Data was collected on: duration of
treatment, number of injections, side effects, reason for discontinuation,     Objectives: The effects of oral contraceptives (OC) on lipid metabolism
weight gain, serum oestradiol level, bone density result, and PMS              have been investigated extensively. In a recently performed clinical trial
symptoms. Patients were called for a repeat injection at 12 weekly             we generated data on the long-term effect of two low-dose OC with
intervals, earlier if required, after 6 weeks from last injection. Blood       different doses of both levonorgestrel (LNG) and ethinylestradiol (EE)
pressure, weight, including side effects were recorded at each visit.          on serum lipids and lipoproteins.
Serum oestradiol level is carried out at 2-3 yearly intervals, earlier in      Study Methods: In a double-blind, randomized, parallel-group, multiple-
symptomatic women. Bone density scan arranged in patients with                 dose study 67 healthy women aged 18 to 35 years received either Leiosâ
prolonged amennorhoea (>2 years) and low serum oestradiol.                     (0.02 mg EE/0.1 mg LNG, n=34), or Stediril 30â (0.03 mg EE/ 0.15 mg
Results: Depo-Provera is an extremely effective contraceptive                  LNG, n=33) for 12 consecutive cycles. Blood samples were taken twice
independent of users’ compliance with no reported failure of pregnancy.        before treatment and at the end of cycles 3, 6, and 12.
Fertility returned on average 12-18 months after the last injection,           Results: Serum triglycerides (TG) showed the most significant changes.
(earliest pregnancy 3 weeks, latest 22 weeks). 31% of patients continued       For total TG as well as TG in the different lipoprotein fractions a marked
with this method of contraception, majority of patients stopped after 4-6      increase after 3 and 6 treatment cycles was observed. Total cholesterol,
injections. Reason for stopping: irregular bleeding 21%, weight gain           LDL- and VLDL-C only slightly increased whereas HDL-C showed
with bloatedness 44% (average weight gain 6kg, range 2-22kg), loss of          only minor alterations. In addition, apolipoprotein E decreased whereas
libido 5%, vaginal dryness 16%, symptoms similar to menopause 14%,             apolipoprotein B slightly increased. Regarding lipoprotein (a) and
hot flushes, depression, tiredness, etc. 2% patients stopped due to            apolipoprotein AI no changes were detected. There were no significant
recurrent abdominal pains. No significant blood pressure change noted          differences between the treatment groups.
in long term users. 59% of patients who had continued with injection           Conclusions: The well-known influence of oral contraceptives on serum
more than 3 years had low serum oestradiol. 70% of them had level              lipids and lipoproteins have been confirmed. Comparing the two low-
below 52 mmol/l and most were symptomatic. Bone density scan was               dose LNG/EE formulations Leios and Stediril 30, no major differences
arranged on patients with serum oestradiol below 100mmol. Only 18%             were observed.
had low bone density. 65% of symptomatic patients with low serum
oestradiol have stopped the injection and opted for alternative
contraception, 30% patients continued with addback estrogen, 2% of             P1.05.07
asymptomatic patients continued with low estrogen, 3% refused all              UNDERSTANDING FACTORS INFLUENCING REQUEST FOR A
contraception. 70% of patients became amennorhoic after 3 injections.          REPEAT TERMINATION OF PREGNANCY
Conclusion: Injection Depo-Provera is an extremely effective                   S.K. Tewari, O. Diaz-Morales, D. Rennie Urquhart, T.A. Mahmood,
contraceptive suitable for non-compliant patients with side effects of         Forth Park Hospital, Kirkcaldy, Fife, U.K.
weight gain and lowering of serum oestradiol level due to ovulation
suppression and prolonged amennorhoea. Fortunately the effect on bone          Abstract: Despite the opposition of the great religions of the world,
density is minimal and it can be offered as a first line to willing patients   termination of pregnancy has been practiced throughout the history of
after counseling for regular follow-up.                                        mankind. Over the centuries, the procedure of procuring an abortion has
92                                                                                                                     MONDAY, SEPTEMBER 4

become safer, cost effective and more acceptable to women. However,         Study Methods: Normal breast tissue was collected at the time of benign
there is an increased moral and ethical objection among medical as well     lump biopsy by removing fragments of breast parechima located at least
as nursing professionals against termination of unwanted pregnancy.         1 cm from the lesion. The biopsy took place between the 22nd and 25th
Additionally, protest by the anti-abortion camp is steadily mounting. In    day of menstrual cycle, either in the control group (without oral
developed countries information about family planning is widely             contraceptive - 11 women) or in the study groups (with oral
available, yet the number of terminations of unwanted pregnancy has         contraceptive – 13 women). The proliferative activity was evaluated by
been rising. This study will hopefully shed some light on why women         the PCNA expression.
ask for a repeat termination.                                               Results: In the study group the average PCNA expression was 16.78%
Objective: To investigate and understand the reasons behind a woman’s       where as in the control group was 13.72% (Mann Whitney Test P =
request for a repeat termination of pregnancy. We are carrying out this     0.14173).
prospective questionnaire based study, inviting, 100 consecutive women      Conclusions: Our results showed that there is no difference in PCNA
requesting a repeat termination of pregnancy at our one stop social         expression of mammary epithelium among oral contraceptive users
gynecology clinic at a Scottish general hospital. This on-going study       during two cycles of treatment.
involves completing a structured questionnaire on a one to one basis.
There are two questionnaires, one being completed before TOP and the
second one after the procedure. We are using Edinburgh postnatal            P1.05.10
depression questionnaire, SF12 & Nottingham women’s health                  LAM IN A POSTPARTUM FAMILY PLANNING PROGRAM:
questionnaire and are also collecting information about their               CHILDREN’S HEALTH OUTCOMES
psychosocial background and contraceptive practices, which may have         J.G. Cecatti, A.S. Araújo, M.J.D. Osis, Dept. OB/GYN, School of
some bearing on their decision making. Preliminary data suggests that       Medical Sciences, University of Campinas, Campinas, SP, Brazil
new models of service delivery be developed to offer effective pre-
conception contraceptives (morning after contraception strategy). We        Objectives: To evaluate the effect of introducing LAM (lactational
will present our fully analyzed data at the conference.                     amenorrhea as a contraceptive method) into a postpartum family
                                                                            planning program.
                                                                            Study methods: The duration of the total and exclusive breastfeeding
P1.05.08                                                                    and some indicators of the child health up to one year of age were
EMERGENCY CONTRACEPTION WITH MULTILOAD CU 375SL                             evaluated, comparatively between women who received the traditional
IUD : A MULTICENTRE CLINICAL TRIAL                                          (A-before intervention) and those who participated in a new program of
Zhou Liying and Xiao Bilian, National Research Institute for Family         orientation (B-after intervention), that included LAM as a new
Planning, No. 12 Da Hui Si, Hai Dian Qu, Beijing 100081, China              contraceptive choice. This was an operational study, which was
                                                                            performed in Recife, PE, Brazil, including data of 698 women who had
Objectives: To further evaluate the efficacy of insertion of Multiload      prenatal care and delivery at the same institution. The statistical
IUD for emergency contraception, the side effects and the benefits and      procedures used were the x2 , x2 for trend, Student t test, survival
limitations of using IUD for emergency contraception                        analysis, and Cox logistic regression.
Subjects and Methods: A total of 1013 women requesting emergency            Results: There was no difference between the groups regarding literacy,
contraception was recruited, among which 838 were parous women and          marital status, number of live births, number of previous abortion,
170 nulliparous women. Multiload CU 375 SL IUD was inserted within          number of children alive, duration of breastfeeding of the previous child
120 hours after unprotected intercourse. Urine test for pregnancy was       and route of delivery. Group A had a higher (85,6%) infant morbidity up
performed before IUD insertion to rule out pregnancy. Subjects were         to 2 months than Group B (72,1%). The number of hospitalizations was
followed up one week after the expected day of the next menstruation.       more than the double for the children of Group A. The weight and the
Pregnancy test or ultrasound scanning were performed if menstruation        height of the children at 12 months were significantly higher in Group B.
did not return. Efficacy of preventing unplanned pregnancy was              The cumulated rates of total breastfeeding were significantly higher in
calculated according to Dixon’s method. Efficacy and side effects were      Group B.
compared between the parous and nulliparous groups.                         Conclusions: This intervention could be applied to other settings,
Results: There were two pregnancies, one in each group, the efficacy        providing its contraceptive efficacy and its positive effects on child
rate in the parous groups was 97.8% and 90.96% in the nulliparous           health.
group, the difference was not significant.. The total efficacy rate was
96.46% and the pregnancy rate was 0.2 per 100 women. Removal of
IUD due to pain and bleeding after IUD insertion were more in the           P1.05.11
nulliparous group. After the return of menstruation 95.7% in the parous     INITIAL RESULTS OF THE USE OF A NEW TUBAL LIGATION
group and 80% in the nulliparous group continued using IUD for              TECHNIQUE
contraception. There were 2 complete expulsion and 3 partial expulsions     A. Molina, C.F.F. Costa, G. Marques, Dept. OB/GYN, Faculdade de
of IUD. Menstrual changes and bleeding were not significant. No             Ciências Médicas, Universidade de Pernambuco, Brazil
infection nor trauma occurred.
Conclusion: IUD insertion is a safe and effective method for emergency      Objectives: The aim of this study was to investigate the results of the use
contraception for both parous and nulliparous women. The advantages         of a new tubal ligation technique, which does not cause changes in the
of using IUD is its long term contraceptive effect. It can be a method of   mesosalpingy and is easier to be reversed, in case of regret, consisting of
choice even in nulliparous women who have previous induced abortions.       blocking the Fallopian tubes by occluding them with 4 ligatiures at the
Care should be taken in prophylactic measures in women with history of      isthmus. Two ligatures are made with absorbable material without
reproductive tract infection.                                               reaching the mesosalpingy, with a distance of 0.5 cm between both,
                                                                            followed an excision of this segment of tube in a V shape, without
                                                                            reaching the mesosalpingy either. The two ends of the tube are also
P1.05.09                                                                    ligated by absorbable material.
PCNA EXPRESSION IN EPITHELIAL CELLS OF NORMAL                               Study Methods: Descriptive study (series of cases), using the hospital
BREAST TISSUE AFTER THE ADMINISTRATION OF ORAL                              records and interviews to 37 women submitted to Molina-Costa tubal
CONTRACEPTIVE.                                                              sterilization at Pernambuco State University (UPE) Maternity Hospital
D.G. Narvaiza, A.C.P. Nazário, V.N. Alberti, E.C. Baracat, G.R. Lima        (CISAM).
Dept. Ob/Gyn. Federal University of São Paulo, 715 Napoleão de Barros       Results: The mean age of the population studied was 31 years old,
Street – 7th floor, São Paulo, SP, Brazil, 04023-900.                       having 3.7 children alive. The average time of having been sterilized
                                                                            was 18 months (maximum of 49 and minimum of 1 month). Our
Objectives: The aim of the study was to determine the proliferative         findings showed that there was no failure until now and no
activity evaluated by the PCNA expression in epithelial cells of normal     complications in short or long term. Regarding menstrual changes and
breast tissue after the administration of levonorgestrel 0.15 mg and        pelvic pain the results were similar to those described in the international
ethinyl stradiol 0,03 mg during two cycles of 21 days (with 7 days          literature.
between pill packs)                                                         Conclusion: Taking into account the Bioethics Principles of
                                                                            Nonmaleficence and Beneficence our results support the view that this
MONDAY, SEPTEMBER 4                                                                                                                                 93

tubal ligation techinique is a considerable good family planning option,     training for hospital staff which focused on PAFP counseling,
mainly in areas of high level of regret as it occurred in Brazil.            communications skills, contraceptive technology, infection prevention
                                                                             and MIS. Each site was followed up regularly for feedback and data
                                                                             collection (service statistics).
P1.05.12                                                                     Results: 10 out of 12 hospitals have been followed for an average of 9.2
ARTIFICIAL ABORTION INSTEAD OF CONTRACEPTION AT                              months (range 5-12 months) so far. Since the intervention 4177 women
THE BEGINNING OF THE THIRD MILLENNIUM: WHY?                                  have had abortions in these hospitals. While the average initial PAFP
T. Moskovic, L. Tasic, B. Tosic, B. Bojovic, T. Kilibarda, University        acceptance rate was 45.8%, by the end of the 5th month following the
Hospital of OB/GYN Narodni Front, Belgrade, Yugoslavia.                      intervention it increased to 74.2%. 6 hospitals have completed the 10th
                                                                             month and their average score is 76.6%.
Objectives: The number of legal artificial abortions has been dropping,      Conclusions: More than two thirds of abortions are done in the private
but there are still about 4000 abortions per year in our hospital. The aim   sector in Turkey and so far systematic provision of PAFP services has
of the study was to investigate the reasons for women’s decision for         not been their priority. This initiative has proved that PAFP can work in
artificial abortion – what do women know and what is their attitude          the private sector. However it requires an integrated approach, tailored
towards contraception?                                                       to the needs of the individual hospital. Its vital elements are: the
Study Methods: 436 women (15-47 years) who came to our hospital              commitment of managers and staff to adding FP to the abortion service;
asking for legal termination of pregnancy were interviewed with a            providing counseling training for staff; and having adequate space, FP
written form by a gynecologist. All women were 5 – 20 weeks pregnant,        commodities, and relevant informational and educational materials
49% were employed, 9% were still in school, 76% married and only             available for clients. In addition PAFP is highly replicable.
10% had higher education.
Results: There are many reasons for the decision of termination of
current pregnancy, but unfortunately the majority of women (44.1%)           P1.06   DRUG DELIVERY SYSTEMS IN
simply do not plan for more children and 21.2% of the reasons depend                 OBSTETRICS AND GYNECOLOGY
on an inadequate socioeconomic status. More than 90% of all women
knew about IUD, pills and the natural method of contraception. The           P1.06.01
most efficient methods of contraception, in their opinion, are IUD and       STUDY OF DANAZOL TREATMENT IN HABITUAL
pills. The most dangerous methods are pills and IUD. Only 26% of all         MISCARRIAGE
women had asked their doctor for advice about contraception and only         Y. Sawatari (1), Y. Sawatari (1), H. Hoshiai (2), T. Funato (3)
30% had been advised about contraception by doctors. 28.7% of women          (1) Sawatari Women’s Hospital, Osaka, Japan.
have used one or two contraceptive methods. 68.1% of all women have          (2) Dept. OB/GYN, Kinki University Hospital, Osaka, Japan.
used come local or natural method of contraception at the time of            (3) Dept. OB/GYN, Nissei Hospital, Osaka, Japan.
conception of their current pregnancies.
Conclusion: Although women have basic information about                      Objectives: The aim of the study was to investigate the effect of danazol
contraceptive methods, they are often misinformed. Due to less               treatment in habitual miscarriage of unknown cause.
motivated and educated doctors and an indifferent attitude to curettage,     Study Methods: We administered 400 mg/day of danazol for one month
they repeatedly ask for the termination of unwanted pregnancy and            to 7 patients suffering habitual miscarriage of unknown cause.
artificial abortion has become a method of family planning.                  Measurement was made by serum NK activity before and after danazol
                                                                             Results:Two of the patients eventually miscarried, but miscarriage-
P1.05.13                                                                     preventive effects were seen in 5 patients (a miscarriage preventive rate
SAFETY AND EFFICACY OF DMPA AT MODEL FAMILY                                  of 71.4%).
PLANNING CLINIC OF DHAKA MEDICAL COLLEGE HOSPITAL                            In habitual miscarriage patients, NK activity is enhanced at an average
Dr Mariam Faruqui* , Dr Jaglul Haider Khan** , Prof Anowara Begum            of 59.8%, but with the administration of danazol, it significantly
***, *Consultant (Obs/Gynae) Dhaka Medical College, Dhaka,                   decreased to 45.1% (P<0.01).
Bangladesh, **MO, SSMC & Mitford Hospital, Dhaka, Bangladesh,                However, in one patient who eventually miscarried, NK activity did not
***Head of the Deptt. of Obs & Gynae, Dhaka Medical College                  decrease and a high level was maintained even with the administration
Hospital, Bangladesh.                                                        of danazol.
                                                                             Conclusion: These results suggest that danazol administration may be
This was a prospective non comparative clinical study of 3580 cases of       effective for habitual miscarriage and that NK activity may be used as a
DMPA acceptors done during a period of 4 year in Model Family                treatment maker.
Planning Clinic of Dhaka Medical College Hospital (DMCH). The
acceptors were followed up for subsequent 6 months. We do not know
about the cases who did not came for follow up visit. Most common side       P1.06.02
effect was found to be amenorrhoea (75%) and common cause of                 PREMENSTRUAL SYMPTOM SEVERITY: EFFECT ON SOCIAL
discontinuation was spotting (21%). There was improvement of                 FUNCTIONING AND TREATMENT SEEKING BEHAVIORS
dysmenorrheoea with passage of time. No significant effect on BP and         R.L. Robinson (1), R.W. Swindle (1,2)
body weight. Discontinuation rate was found to be about 10%. These           (1) Health Outcomes Evaluation Group, Eli Lilly and Company,
results are more or less similar to other studies on injectable                  Indianapolis, Indiana, USA.
contraceptives.                                                              (2) Dept. Psychology, Indiana University-Bloomington, Bloomington,
                                                                                 Indiana, USA.

P1.05.14                                                                     Objectives: The purpose of this study was to understand premenstrual
PRIVATE SECTOR EXPANSION OF A POSTABORTION FAMILY                            symptomatology and treatment-seeking behaviors by examining three
PLANNING INITIATIVE IN ISTANBUL, TURKEY                                      measurement approaches for premenstrual symptoms, their relationship
L. Cagatay (1), J. Ergin (3), J. Haws (2), C. Bumin (1), P. Senlet (4)       to social functioning interference, and the role of symptom severity in a
(1) AVSC International, Ankara, Turkey.                                      broader model of help-seeking for premenstrual symptomatology.
(2) AVSC International, New York, New York, USA.                             Study Methods: Cross sectional data were obtained from 1022 mail
(3) AVSC International, Istanbul, Turkey.                                    survey respondents who were derived from a nationally representative
(4) US Embassy, Ankara, Turkey.                                              random sample of women, age 18 to 45, experiencing regular menstrual
                                                                             cycles. Statistical analyses included Pearson correlations, chi-square
Objectives: The aim of the postabortion family planning (PAFP)               tests, t-tests, and logistic regression.
initiative was to increase family planning (FP) acceptance rates of          Results: Symptom severity measures were strongly inter-correlated
women undergoing abortions in private hospitals thus resulting in a          ranging from .60 to .78 (p,<0.001), and were correlated with interference
decrease in induced abortion.                                                in social and occupational functioning domains, ranging from .44 to .77
Study Methods: Between December 1998 and June 1999, PAFP was                 (all p<0.001). Although a DSM-IV adapted approach identified 11.3%
initiated in 12 hospitals in Istanbul. Its main component was the on-site    of women with premenstrual dysphoric disorder (PMDD), of whom 92%
94                                                                                                                      MONDAY, SEPTEMBER 4

also reported social interference, only 4.9% of women self identified        from the doses of 500 mg/kg and the lesions on these organs are
themselves as having severe symptoms. Treatment seeking was                  dependent doses.
predicted by older age, recurrent symptoms in most cycles, greater self
reported symptom severity, greater overall use of healthcare services,
and less negative attitudes toward “premenstrual syndrome” (all              P1.06.05
p<0.05).                                                                     PHARMACOKINETIC STUDY OF THE SURGICALLY OCCLUDED
Conclusions: Women under-identify the severity of their premenstrual         ARTERIAL INFUSION METHOD
symptoms despite the fact that these difficulties are associated with        S. Kamoi, M Matsusita, Y. Ohta, H. Konishi, T. Kawamura, T. Araki
consistent social and occupational interference in most life domains.        Dept. OB/GYN, Nippon Medical School, Tokyo, Japan
Women are also reluctant to seek help for treatable PMS symptoms due
to attitudinal barriers regardless of the severity of their PMS symptoms.    Objectives: The purpose of this study was to evaluate the
These findings support the feasibility of clinician’s use of brief           pharmacokinetics of a newly developed intra-operative arterial infusion
screening approaches for PMDD especially utilizing short summative           method so as to augment the efficacy.
symptom rating scales.                                                       Study Methods: For nine patients with FIGO stage I uterine cervical
                                                                             carcinoma, 200mg/m2BSA of carboplatin was administered for 20
                                                                             minutes from the distal part of bilateral hypogastric arteries of which the
P1.06.03                                                                     central part was clamped with vascular forceps before modified radical
CERVICAL RIPENING AND INITIATION OF DELIVERY WITH                            hysterectomy and bilateral pelvic lymphadenectomy. Carboplatin was
INTRACERVICAL OR INTRAVAGINAL PROSTAGLANDIN GEL                              also administered intravenously to two patients. The platinum
E. Richer, C. Kerdudo, A. Simionescu, P. Vige, Dept. OB/GYN, Hôpital         concentration of the surgical specimens and peripheral blood were
de Saint-Cloud, Saint-Cloud, France                                          measured by atomic absorption spectrophotometry.
Objective: The purpose of this study was to assess and compare a             1) With this method, the platinum concentration of the cervix
sequence of prostaglandin gela administered either intravaginally or               endometrium, ovary, external iliac nodes and interiliac nodes were
intercervically, which was followed by amniotomy and OCYTOCIN                      2.91±2.13, 4.00±2.19, 8.42±5.76, 1.42±0.91 and 1.20±1.01g/g wet
infusion.                                                                          tissue, respectively.
Study Methods: Two prospective series of 30 EM-P with Bishop scores          2) The free platinum concentration of the serum 30 minutes, one
ranging between 3 and 8, who were scheduled for induction received 0.5             hour, two hours, four hours, eight hours and 24 hours after infusion
mg of PgE2 intracervically or 2mg of PgE2 intravaginally. Patients were            were 6659±1667, 4551±1309, 2679±1158, 992±395, 288±119 and
eventually re-administered the intracervical gel at 12 hours or the                3±0 mg/ml, respectively.
intravaginal gel at 6 hours. Once labor was induced, an amniotomy was        3) In two intravenous infusion cases, the tissue platinum
performed and an OCYTOCIN infusion started and adapted to                          concentration showed undetectable level in several samples while
contractility.                                                                     the plasma free platinum concentration showed almost the same
Results: 100% of the women went into labor and delivered in less than              level as the concentration obtained by this intra-arterial infusion
15 hours (mean = 10:10), (mean Apgar score: 9-10-10). No uterine                   method.
rupture was reported. In the intracervical gel group, Bishop’s score was     Conclusions: This method was thought to be effective for systemic
modified more. There were more women in labor after 2 hours and the          treatment as well as local treatment; however, more control cases are
onset to birth was shorter. In the intravaginal gel group. There were        necessary to prove the difference of pharmacokinetics from usual
fewer uterine hypertonia (not significant) and fewer C-sections (p =         intravenous administration.
0.05) all told: 16%.
Conclusions: In EM-P women with Bishop’s score between 3 and 9, the
combination of a locally administered PG E2 + amniotomy +                    P1.06.06
OCYTOCINE is efficacious and safe to induce delivery. The                    THE ROLE OF SOMATOTROPIN IN THE LACTOGENESIS
intracervical gel is more efficacious on the cervix but causes slightly      PROCESS
more Cesarean sections.                                                      N.A. Morozova, A.B.Mamonov, E.A. Sirotina, S.M.Kornienko, Dept.
                                                                             OB/GYN, Medical University, 20A/3 Polotskaya str., Donetsk,
                                                                             Ukraine, 83092.
ACTION OF PARACETAMOL ON THE LIVER AND KIDNEYS OF                            Objectives: The aim of the study was to investigate the secretion of
PREGNANT FEMALE RATS AND THE NEWBORNS                                        somatotropin in puerperants in the lactogenesis period and to determine
J. Andalaft Neto, O. A. Mora, E. T. R Mendes, M. J. Simoes, L. Kulay         the dependence of somatotropin secretion level from the time of
Jr., Dept. of OB, Federal University of Sao Paulo, Escola Paulista de        breast-feeding start.
Medicina, Sao Paulo, Brazil                                                  Methods: The level of somatotropin in serum was determined by means
                                                                             of radio-immunological method using CIS (France, Belgium, Italy) in
Objective: The aim of this work as to evaluate with light microscopy the     214 puerperants on the 3rd and 6th days of lactation. The two groups of
lesions on maternal and fetal liver, and maternal and fetal kidneys during   patients were under investigation. The first control group (A)
the whole pregnancy of the albino female rat (0-20 days), after chronic      consisted of 111 healthy puerperants who started breast-feeding
use of the paracetamol.                                                      immediately after delivery in the obstetric unit. The second group B
Study Methods: 40 pregnant albino female rats were submitted the             consisted of 103 puerperants who started breast-feeding 24 hours later
action of the paracetamol, from the zero to the 20th day of pregnancy.       problems with health condition.
The animals were divided in four groups: Group I was the control; group      Results: There was a statistically significant increase of somatotropin
II received daily by oral route 125 mg/kg of paracetamol; group III          level during the lactogenesis period in group A. On the 3rd day after
received 500 mg/kg; group IV 1500 mg/kg/day. In the 20th day, the            delivery the level of somatotropin was found to be 1.7-- 0.1% g/ml, by
female rats were sacrificed and samples of the liver and kidneys of the      the 6th day it had amounted to 2.5 * 4.0% g/ml (p<0.05). In group B this
rats and its newborns were obtained and submitted to histological study.     level was registered as 1.5 * 0.3% g/ml on the 3rd day and 2.1 -- 0.2%
Results: In groups I and II no changes were found in the liver and kidney    g/ml (p<0.05).
of female rats and newborns. In group III, necrosis and adipose              Conclusions: The research conducted showed the increase in
infiltration were observed in the maternal liver. The livers and kidneys     somatotropin level in puerperants* blood observed during lactogenesis .
of the fetuses showed no changes. The maternal kidney exhibited tubules      The most significant rise in somatotropin level was registered on the 6th
and glomerulos necrosis. Group IV showed numberless hepatocytes with         day after delivery. There was a certain interdependence observed
picnotic nuclei and destruction of the cytoplasmic architecture. Collagen    between the growth in somatotropin level and early start of breast-
fibers were observed in the fetal liver and the fetal kidneys. The           feeding. Thus the activation of somatotropin secretion is taking place in
maternal kidney showed glomerular atrophy as well as tubular necrosis.       the late lactogenesis period after colostrum stage is over. It proves that
Conclusions: At light microscopy in the used doses, adverse effects were     human somatotropin plays an important role in the lactation function in
not observed on the fetuses. With relationship to the pregnant female        women.
rates, deleterious effects were observed on the liver and kidneys starting
MONDAY, SEPTEMBER 4                                                                                                                                 95

P1.06.07                                                                     groups: GA : 10mg sufentanil + 2,5 mg bupivacaine; GB: 5mg sufentanil
THE ULTRASOUND METHOD OF MAMMARY GLAND                                       + 2,5 mg bupivacaine. We analyzed using chi-square test P value< 0.05
INVESTIGATION AS LACTATION MALFUNCTION                                       indicated statistical significance.
PROGNOSIS METHOD.                                                            Results: Data expressed as mean ±SD. The table summarized all the
N.A. Morozova, Dept. OB/GYN, Medical University, 20A/3                       results:
Polotskaya str., Donetsk, Ukraine, 83092.                                                                        GA (n=22)    GB (n=19)         P
                                                                               Duration of analgesia (min)        107±18         99±12        0,12
Objectives: The aim of the study was to investigate the morphological          Failure                            3 (13%)        1 (5%)       0,87
structure of mammary glands in pregnant women.                                 Hypotension                        4 (18%)       3 (15%)       0.76
Study Methods: The mammary gland tissue structure was studied in 127           Pruritis                          19 (86%)*      8 (42%)       0.01*
pregnant women by means of ultrasound scanning in 6 –12; 16-24; 27-            Respiratory depression                 0             0           -
32; 36-40 weeks of gestation. According to the ultrasound picture the          Motor block                            0             0           -
women were devided into three groups. Group I consisted of 58 women
                                                                               Nausea                                 0             0           -
with glandular type of mammary gland structure. Group II was the
                                                                             Failure SA > 30mn criteria was defined by a reappearance of the pair
mixed type group (53 women). Group III consisted of 16 women with
                                                                             during labor.
adipose type mammary glands. Results.
                                                                             Conclusion: Spinal analgesia in advanced labor with 10 mg of sufentanil
 The type of mammary gland structure in the 6—12 week of gestation
                                                                             produce the same length of analgesia but produce more pruritis.
was regarded to be initial as the morphological tissue difference is
insignificant at this stage. Substantial tissue differentiation had taken
place by the 27 –32 week of gestation. Most of the gravidae had a
glandular type structure of both right and left mammary glands (51.8%
                                                                             PREINDUCTION PROSTAGLANDIN E2, GEL OR LAMINARIA
and 40.7% respectively).
                                                                             TENTS PRIOR TO PG ANALOGUES FOR SECOND-TRIMESTER
 Glandular type of mammary gland structure was observed in 98.3 %
gravidae in the late gestation. Adipose type of structure was found in
                                                                             Kravchenko N.F., Gurtovoy B.L., Ordzhonikidze N.V., Tioutiounnik
6.1% and 12.3% women respectively. This type wasn’t observed after
                                                                             V.L. Research Centre of Obstetrics, Gynecology & Perinatology,
27–32 week of gestation. The mixed type structure was registered in the
                                                                             Moscow, Russia
right mammary gland in 34.7% women and in the left one in 17.8%. In
the late gestation mixed type structure was observed only in 3.1%
                                                                             Objectives: A prospective trial was conducted including 250 pregnant
patients. The correlation of adipose to glandular structure as 3:1 at the
                                                                             women who had medical indications for midgestation pregnancy
scanned area resulted in the lactation malfunctions. The correlation was
                                                                             termination to evaluate the safety and efficacy of two-staged 2-nd
estimated in mammary gland quadrants, which proved to be effective.
                                                                             trimester abortion.
The tissue differentiation process was found to take place at different
                                                                             Methods: Subjects received preinduction cervical ripening treatment
rate in different sections. Tissue differentiation was more significant in
                                                                             with intracervical PG E2 gel or Laminaria tents followed 12 h later by
the outer quadrants (both upper and lower).
                                                                             PG E2 or PG F2 alpha intramuscularly. The PG dose was repeated if the
                                                                             abortion did not occur but not exceeding 2 mg a day. All women were
                                                                             randomized into 4 groups depending on different drug combinations.
                                                                             The mean age, parity and meangestational age of patiens of 4 groups
                                                                             were comparable.
                                                                             Results: The mean abortion interval was 8.2 h and the cumulative
M. Molina, R. Perez, K. Fraenkel, X. Vergara, Dept. OB/GYN, Faculty
                                                                             abortion rates at 24 h was 95%. The total dose of the PG required to
of Medicine, University of Conception, Chile.
                                                                             induse abortion and the incidence of side effects or analgetic
                                                                             requirement were significantly less due to cervical pretreatment.
Objectives: To compare the efficiency between Misoprostol and
                                                                             Conclusions: Two-staged treatment regimen appears to be an easy,
Oxitocin in the inducement of the delivery work, a retrospective study in
                                                                             practical, reliable, safe and efficient method of second-trimester
102 full term pregnants was carried out in the Hospital Guillermo Grant
                                                                             pregnancy termination.
Benavente, Conception, Chile (1998-1999).
Study Methods: The group under study corresponded to 51 patients
induced intravaginally with Misoprostol (50ug) and the comparative
group, 51 patients induced intravenously with Oxitocin (2 – 20mu/min).
                                                                             MISOPROSTOL VERSUS OXYTOCIN SAFETY AND EFFICACY
Results: The biodemographic characteristics of both groups were
                                                                             IN INDUCTION OF LABOR
similar, being produced the delivery in the first 24 hours in 67.7% in
                                                                             A. Sabra, H. Abdel-Aleem, A. Abdel-Aleem, A. Shaheen, Dept.
both groups. The duration of the delivery work did not present
                                                                             OB/GYN, Faculty of Medicine, Assiut University, Assiut, Egypt.
significant differences. The only advese motherly affect I the group
with Misoprostol was Polysistolia (33.3% vs 11.8%) p<0.001. In both
                                                                             Objectives: The aim of the study was to compare safety and efficacy of
groups the acute fetal suffering was the principal fetal complication,
                                                                             misoprostol with oxytocin in induction of labor.
21.6% with Oxitocin and 20% with Misoprostol . Free flow oxygen was
                                                                             Study Methods: 2 groups of women suitable for induction were studied.
required with greater frequency in the newborns of the group induced
                                                                             Group A (107 cases) treated with 50 ugm misoprostol inserted in the
with Oxitocin (27.5% vs 11.8%) p<0.05.
                                                                             posterior vaginal farnix, 6 hourly until adequate contraction occurs with
Conclusions: Both methods resulted equally effective for the inducement
                                                                             maximum dose of 200 ugm. Group B (107 patients) were given 5 units
of the delivery work in full-term pregnants but the group induced with
                                                                             oxytocin in 500 ml 5% dextrose drip. All patients were monitored for
Misoprostol presented a significantly greater percentage of polysistolia.
                                                                             fetal wellbeing.
                                                                             Results: Our results showed that misoprostol at the suggested dose
                                                                             associated with shorter but not significant induction delivery interval
                                                                             compared with oxytocin use. Misoprostol use showed higher mean rate
                                                                             of cervical dilation than oxytocin. Cases delivered after one dose of
                                                                             misoprostol mounted up to 58.9% case of non reassuring FHR before
M. Chibani, R. Rachdi, L. Messaoudi, M.B. Kraiem, M. Ferjani, M.
                                                                             induction have been associated with more uterine hyperstimulation with
Dahri, Dept. OB/GYN, Military Hospital, Tunis, Tunisia.
                                                                             and without FHR changes in the misprostol group than in the oxytocin
                                                                             group. Oligohydramnios was identified as a risk factor for induction by
Objective: The aim of this prospective study was to evaluate analgesic
                                                                             misoprostol. C-section rate was equal in both groups. Fetal respiratory
side effects of two doses of intra thecal (IT) sufentanil (5 and 10mg) in
                                                                             acidosis was higher with misoprostol than with oxytocin and was more
spinal analgesia at the end of labor.
                                                                             pronounced with non reassuring FHR or oligohydramnios. Cervical
Materials and Methods: After illuminated consent, 41 parturients
                                                                             tears were higher with misoprostol than with oxytocin medication.
benefited an (IT) analgesia, to cervical dilation ³ 6cm, ASAS-II, with a
                                                                             Conclusions: Intravaginal 50 ugm misoprostol 6 hourly is safer and
pregnancy monofetal, a cephalic presentation and a term ³ 37 weeks of
                                                                             more effective for induction of labor than oxytocin drip. However, good
gestation. The parturient were assigned randomly either in one or two
96                                                                                                                      MONDAY, SEPTEMBER 4

case selection is essential to exclude the high risk group as low BPP <6,     P1.06.14
oligohydramnios, cases not responding to two doses of misoprostol, non        HISTOPATHOLOGICAL AND IMMUNOCYTOCHEMICAL
reassuring FHR before induction and high parity.                              STUDIES ON ABSTRACTED TISSUE AFTER MIFEPRISTONE
                                                                              INDUCED ABORTION
                                                                              Y. Liang, D. Zhu, Reproductive Medical Center, Capital University of
P1.06.12                                                                      Medical Sciences, Beijing, China.
ADMINISTRATION OF COMBINATION ESTRADIOL AND                                   To investigate the relation between bleeding after mifepristone induced
NORETHISTERONE (ESTALISÒ) VIA THE BUTTOCK AND                                 abortion and placental remains in endometrium. Histopathological and
ABDOMEN                                                                       immunocytochemical methods were carried out to study the abstracted
J-P Marty, Faculté de Pharmacie, Université de Paris Sud, Châtenay            (20 patients) and aborted (10 patients) tissue. Histopathological study
Malabry, France.                                                              showed that there was decidua with necrotic cells in the abstracted
                                                                              tissue. A lot of white cells could be seen decidua and endometrium.
Objectives: Study to measure the bioavailability of estradiol and             There were also glands and extracellular materials in different stages of
norethisterone (E2/NETA) when administered transdermally in a                 development. Immunocytochemical study showed that factor VIII
combination patch, comparing placement on the buttock and on the              antigen and PALP were positive in the vascular endothelium of
abdomen.                                                                      remaining decidua and could be the cause of bleeding after mifepristone
Study Methods: This was an open-label, randomized two-way crossover           induced abortion.
study involving 18 healthy postmenopausal women. Subjects were
randomly allocated to one of two treatment groups to receive the
E2/NETA patch (EstalisÒ), delivering 50 mg 17b-estradiol and 250 mg           P1.06.15
norethisterone acetate. Subjects in one group had the patch placed on         FLUOXETINE’S EFFICACY IN IMPROVING MOOD, PHYSICAL
the buttock; the other group had the patch placed on the abdomen.             AND SOCIAL IMPAIRMENT SYMPTOMS ASSOCIATED WITH
Patches were left in place for 4 days. Timed serum samples were taken         PMDD
during this period and for 36 hours thereafter; the groups were then          M. Nilsson (1), R. Judge (2), E. Brown (3), C. Schuler (2)
given a further patch by the alternative placement. Samples were tested       (1) Eli Lilly and Co., Arvada, CO, USA.
for E2, and NETA; maximum serum concentration (Cmax) was                      (2) Lilly Research Laboratories, Lilly Corporate Center, Indianapolis,
determined, and the area under the concentration/time curve (AUC) was              IN, USA.
calculated.                                                                   (3) Eli Lilly and Co., Nederland, CO, USA.
Results: Both E2 and NET achieved higher peak serum concentrations
when given via the abdomen, and total bioavailability (AUC) was also          Objective: A previously reported randomized double-blind placebo-
greater by this route. The mean ratios for abdomen versus buttock levels      controlled crossover trial found fluoxetine effective in reducing PMDD
were as follows: AUC, E2 = 1.24 and NET = 1.28; Cmax, E2 = 1.23 and           symptoms. Data from this study were analyzed to assess fluoxetine’s
NET = 1.19.                                                                   efficacy across 3 symptom clusters: mood, physical, and social
Conclusions: This study demonstrates that absorption of E2/NETA from          impairment.
the combination patch is greater when the patch is applied to the             Methods: 19 patients who met diagnostic criteria for PMDD were
abdomen than when it is applied to the buttock. The abdomen is thus           randomized to receive flexibly dosed fluoxetine 20-60 mg/day and
shown to be the preferred site of application for this delivery system.       placebo, each for 3 consecutive menstrual cycles. A one cycle wash-out
                                                                              preceded the crossover. Mood, physical symptoms and social
                                                                              impairment were assessed by Visual Analogue Scales (VAS), Daily
P1.06.13                                                                      Ratings Form and Premenstrual Tension Syndrome scales (PMTS, both
COMBINED SPINAL EPIDURAL ANALGESIA DURING LABOR                               patient- and clinician-rated). Outcome measures included average
COMPARISON OF THREE PROTOCOLS                                                 within cycle changes from follicular to luteal phase and average luteal
R. Rachdi, M. Chibani, L. Messaoudi, M.B. Kraiem, M. Ferjani, M.              phase scores.
Dahri, Dept. OB/GYN, Military Hospital, Tunis, Tunisia.                       Results: At baseline, all patients had significant increases in
                                                                              symptomatology from follicular to luteal phase. During fluoxetine
Objective: The aim of this study was to evaluate analgesic side effects       treatment, patients demonstrated significantly smaller mean increases
and obstetrical repercusum of two doses of intrathecal (IT) sufentanil (5     from follicular to luteal phase than during placebo treatment in VAS
and 10 mg) and the addition of a dose of clonidine (30mg).                    Mood-4 subtotal (mood swings, depression, irritability, anxiety; p=.002),
Materials and Methods: During the period going from July 1998 to July         VAS Physical Symptoms subtotal (breast pain, bloating, physical
1999, after illuminated consentement, 105 parturient benefited a (CSE),       discomfort; p<.001) and VAS Social Impairment subtotal (work
to cervical dilation £6cm, ASAI-II, with a pregnancy monofetal, a             efficiency, social activity; p=.002). Significant improvement occurred in
cephalic presentation and term >37 weeks of gestation. The parturient         the first treatment cycle and was generally maintained during subsequent
were assigned randomly either in one of the three groups: G S5: 5 mg          cycles. Most secondary outcome measures confirmed these findings.
sufentanil + 2.5 mg bupivacaine in IT; G S10: 10mg sufentanil + 2.5 mg        Conclusions: Fluoxetine was superior to placebo in improving a
bupivacaine in IT; G C30: 5mg sufentanil + 2.5 mg bupivacaine + 30 mg         spectrum of PMDD pathology including mood, physical and social
clonidine in IT. After IT, drug injection via a CSE catheter was placed       impairment symptoms.
to provide continuous analgesic with bupivacaine 0.125%. Data
expressed as mean ±SD. We analyzed using ANOVA and Chi-square
test. P value <0.05 indicated significance.                                   P1.06.16
Results: This table summarised all the results                                INTRA- AND INTER-INDIVIDUAL DIFFERENCE IN
                                    G S5     G S10        G C30         P     PHARMACOKINETICS OF A TRANSDERMAL ESTRADIOL GEL
 Baseline cervical dilation (cm)    3±1       3±1         3±1          NS     AND A PATCH
 Duration of IT analgesia (min)    99.9 28   112 67      133 45*     0.003    A-C. Bäckström (1), A. Järvinen (2), C. Elfström (3), A Viitanen (1)
 Cesarean delivery (%)                6        10          20        0.001    (1) Orion Pharma, Espoo, Finland.
 Hypotensia (%)                       3        3           30*       0.022    (2) Dept. of Medicine, Helsinki Univ. Central Hospital, Finland.
 Pruritis (%)                        70       90*          67        0.0034   (3) Quintiles, Uppsala, Sweden.
 Bromage 1 (%)                        7        6            6          NS
 Sedation                            13        25          46*       0.002    Objectives: Transdermal dosing in HRT with new formulations is
Conclusions: The addition of clonidine (30mg) to sufentanil prolongs          increasing. Some formulations are bioequivalent variable estradiol (E2)
analgesia with producing side effects (hypotensia, sedation). We              concentration profiles are often observed. There is a high variability in
recommend the dose of 5mg of sufentanil that produces the same length         absorption of estrogen with tablets and gels as well as poor absorption in
of analgesia that 10mg with less undesirable effects.                         some individuals with patches. We have compared the absorption of E2
                                                                              from a gel and a patch in 24 postmenopausal women.
                                                                              Treatments: mg E2 daily as gel (Divigel®/Sandrena® 0.1% gel, Orion
                                                                              Pharma, Espoo, Finland) and Evorel® 50 mg/24h patch replaced
MONDAY, SEPTEMBER 4                                                                                                                                      97

alternating every 4th and 3rd morning using normal application                 P1.06.18
procedures.                                                                    EFFECT OF TRANSDERMAL HORMONAL REPLACING
Study Methods:The women were treated for 19 days with both                     THERAPY ON MAMMARY PARENCHYMA’ S THICKNESS.
preparations in this open, randomized, two-way crossover study.                S. Staiano, A. Nucci, C. Lampariello, G. De Placido. Clinical
Venous blood samples for E2 and estrone concentration determinations           Department of Obstetric and Gynecological Emergency and Medicine of
were taken on the 15th and 18th study days for the gel and on the 15th         Reproduction – “Federico II” University – Naples – 87100 ITALY
–19th days for the patch.
Results: The peak E2 concentration 374±43 pmol/L (mean±SEM) or the             Objectives: The purpose of our study is to evaluate any possible change
AUC over 15th-19th study days 20.008±1.968 pmol*h/L for Divigel did            in mammary parenchyma’s thickness on menopausal women receiving
not differ significantly from those for Evorel (peak 348±30 pmol/L,            replacing hormonal therapy.
AUC 15.672±1.280 pmol*h/L). However, trough E2 level during                    After menopause the thickness of mammary parenchyma is affected by a
Divigel (106±11 pmol/L) was significantly higher than during Evorel            physiological regression.The average thickness, examined by a 7.5MH2
(76±7 pmol/L, p=0.0401). Equally a higher fluctuation index                    linear tube- ultrasonograph, was 8.6+ 0.40mm. in 91 healthy post-
(calculated as Cmax-Cmin/AUC) was observed for Evorel (1.67±0.08) than         menopausal women (55-68 years old) non treated with RHT and not
for Divigel (1.25±0.10). Differences for AUC varied maximally 6.4 fold         affected by a mammary pathology; it was 9.40+ 0.40mm. in 53 women
for Divigel and 8.4 fold for Evorel and peak E2 varied maximally by 11         with a range of 35 to 50 years, regularly menstruant and non affected by
fold 7 fold respectively. There was no significant differences in trough       a mammary pathology.
E2 levels or AUC between the 15th and the 18th study days on Divigel           Study Methods: We examined 70 menopausal women pre and post-
treatment whereas a statistically significant difference was observed in       transdermic cyclic therapy 17-B-estradiol and noretystheron (?) in order
peak E2 concentration (p=0.0391). For Divigel, the inter-individual and        to evaluate the effect of RHT on mammary thickness. The values of
intra-individual coefficients were 31% and 21% for AUC and 30% and             mammary perenchyma’s thickness have been examined on basal
31% for peak E2 respectively.                                                  conditions after a-3-months-therapy, both in the etrogenic and the estro-
Conclusion: The extent of E2 absorption was similar from both                  progestin phasis, and after a 12 months therapy only in the estro-
formulations in spite of slightly wider confidence intervals than              progestin phasis. The basis value of mammary parenchima’s thichness
generally accepted. Inter-individual variability with the gel and the          was 8.2+ 0.66mm. which is typical of the regressive condition of post-
patch was high and of similar magnitude. This indicates that wider than        menopausal mammary gland. After the first three months of therapy the
generally accepted confidence intervals should be applied for                  mean valeu, found during the estrogenic phase, was 9.8+ 0.58mm. and
transdermal E2 formulations and that pharmocokinetic comparisons               9.7+ 0.61mm. during the estro-progestin phase.
should preferably be made on a crossover basis with sampling during            Results: Both the examinations have showed an extremely important
more than one dosing interval to reveal also intra-individual variability.     increase (p<0.001) in mammary parenchyma’s thickness compared to
                                                                               pre-treatment values. After a 12-months-therapy the mean thickness was
                                                                               found to be 10.5 + 0.51mm. At the end of our study no pathologic
P1.06.17                                                                       mammary change was observed.
S. Hajri : SCPM Ettaoufik, Tunis, Tunisia, H.Chelli, dep. OB/GN                P1.06.19
Maternity La Rabta, Tunis, Tunisia, F. Ben Mansour, Clinique de                SAFETY ASPECTS OF THE LHRH ANTAGONIST CETRORELIX
Planning familial-Le Bardo- ONFP, Tunis, Tunisia, N. Guedanna,                 (CETROTIDEÒ)
ONFP, Tunis, Tunisia, B. Elul Population Council, NewYork, USA,                H. Riethmüller-Winzen, ASTA Medica AG, Frankfurt, Germany
G.Fassahian, Population Council, New York, USA, B. Winikoff,                   A.Prothmann, ASTA Medica AG, Frankfurt, Germany
Population Council, New York, USA                                              Th. Reissmann, ASTA Medica AG, Frankfurt, Germany
                                                                               M. Peukert, ASTA Medica AG, Frankfurt, Germany
Objectives: The aim of study was to investigate a simplified regimen           J. Engel, ASTA Medica AG, Frankfurt, Germany
using 200mg of mifepristone and the standard dose of misoprostol in
developing countries, and to demonstrate that the success rate is              Objectives: Cetrorelix presents the first LHRH antagonist ever
comparable to the higher dose regimen. By reducing considerably the            registered. For this purpose clinical trials have been conducted in several
cost of the medical abortion we will make the method available                 indications, primarily for the prevention of premature ovulation in
for developing countries. At the same time, we investigate the ability of      patients undergoing controlled ovarian stimulation (COS).
women to control and terminate their pregnancy by allowing them to             Study Methods: A total of 2725 patients and healthy subjects finished
choose to take misoprostol at home, and reduce the number of visits            treatment with Cetrorelix until January 2000, in 66 clinical trials at 200
without compromising the efficacy and safety of the method.                    centres world-wide in different benign and malignant gynaecological or
Study method: 403 women were included in the study. They are more              urologic indications.
than 18 years old, with less than 56 days of amenorrhea. Before they are       Results: Doses of 0.1 mg up to 10 mg/day for years have been applied.
enrolled in the study, after detailed information of the method, and           In COS a single dose of 3 mg per treatment cycle and multiple doses of
women have the choice to take misoprostol at homeand reduce to Only            0.25 mg/day are used. No residual effects were determined, especially at
2 visits: first visit for mifepristone administration, and the control visit   embryo transfer. Pregnancy, delivery and baby data are comparable to
at day15, to verify the pregnancy termination.                                 published data in this indication. No adverse effect on pregnancy course
Results: For the 386 women who completed the study, the pregnancy              was observed even after treatment of 3 mg/day. 545 vital pregnancies
age was of 44,5±6,1days of amenorrhea, 83 women are unmarried, and             resulted in 318 life births and 159 ongoing pregnancies, 13.8 %
78% (298/382) choose to take misoprostol at home. 11/386 women were            abortions and 2.4% ectopic pregnancies. The rate of singletons
lost to follow up. The success rate is 94.4%(354/375), with 2,4% (9/375)       accounted to 75 % in COS and to 90 % in low dose stimulation
ongoing pregnancies and 3.2% (12/375) incomplete abortion                      protocols. The risk and rate of OHSS was reduced compared to LHRH-
necessitating a surgical abortion Conclusion: As previously described,         agonist treatment.
the simplified regimen of medical abortion with mifepristone                   Conclusion: Treatment with Cetrorelix proves to be a safe and effective
misoprostol, doesn't reduce the success rate, and if giving the choice, the    new therapeutic principle. Cetrorelix is easy to use either in a single or a
majority of women prefer to have abortion at home even in developing           daily multiple dose regimen in the prevention of premature ovulation of
countries without extensive experience of the method                           patients with ovarian stimulation.
98                                                                                                                     MONDAY, SEPTEMBER 4

P1.06.20                                                                     practitioner with no effect. Physical examination on admission showed
THE USES OF LOW DOSE ASPIRIN (150 MG/DAY) IN                                 mild fever (37,8 C°) and a decreased breathing on the left side. A chest
PRIMIGRAVIDA REDUCES THE SERVERITY AND                                       X-ray documented a partial left pneumothorax and prompted an early
COMPLICATIONS OF PREGNANCY INDUCED HYPERTENSION                              stage pulmonary interstice disease.
Dr. Elmahaishi m.s., Elmegrab - HM Misurata Central Hospital                 She had discontinued cigarettes (35/day) roughly 3 years ago.
p.o. box 65 Misurata Libya                                                   Laboratory data were within the normal range. US scan of the pelvis
                                                                             detected a fibroid of the uterus. Lymphangioleiomyomatosis (LAM) was
Objectives : to evaluate the uses of low dose asprin (150mg) in              suspected. Bronchoscopy was then performed with transbronchial
preventing or reducing the complication of pregnancy induced                 biopsy showing pulmonary fibrosis, alveolar hemosiderosis and focal
hypertension (PET).                                                          areas of smooth muscle cells proliferation: this finding was consistent
Study methods : It is a randomized prospective study for one year (1st       with LAM. Progesterone unlike oestrogen receptor assays were positive
Jan.- end Dec 99) they were 910 primigravida patient who randomly            on the sample. High resolution CT of the chest documented a pattern of
divided to two groups.patients in group 1 were taking asprin from 20         bullous emphysema.
weeks of gestation until delivery . patients in group 2 were not taking      A therapy with GnRH-analogue (Decapeptyl 3,75 mg depot, 1 ampoule
asprin, the diagnosis of PET was based on increases in blood pressure        every month) was started.
and presence of protienuria.                                                 When last seen in February 2000 the patient was well.
Results : 538 patients were in group 1 while 372 patients in group 2.        Lymphangioleiomyomatosis (LAM) is a rare and life-threatening disease
total number of PET were 42 patients, 19 were in group 1 and 23 were in      of females, usually of reproductive age (1). It seems to be caused by an
group 2 in group 1 there were no severe PET patient and they had             abnormal proliferation of smooth muscle in mediastinal, retroperitoneal
complications their stay in hospital were normal as in non PET patient in    and pulmonary lymphatics and lymph nodes. Intrabdominal (i.e. uterine)
group 2 the complication and severity of PET were obvious and has            leiomyomata may be associated. Spontaneous pneumothorax, pleural
statistically significant deferent , patients of group 2 had long stay in    effusions and dyspnea progressing to pulmonary insufficiency are the
hospital, severe PET, IUGR, IUFD, higher C.S.rate and more admission         most usual clinical aspects of LAM. Without treatment, death usually
to ICU.                                                                      occurs within ten years from the onset of the disease. A restrictive where
Conclusions : The uses of low-dose (150mg) of asprin in primigravida         not an obstructive pattern is documented by spirometry. Laboratory,
can reduce the severity of PET and prevent the complications of              such in this case, may be unremarkable. Diagnosis is suspected after a
pregnancy induced hypertension and gives normal fetus with low or no         CT scan of the chest and confirmed by bronchoscopy with
morbidity .                                                                  transbronchial biopsy. Radiologically lesions appear as fine and nodular
                                                                             basal densities evolving towards a bullous emphysema, fibrosis and
                                                                             honeycombing of the whole lung. Typical finding is the abnormal and
P1.06.21                                                                     laminar proliferation of the smooth muscle of lymphatic vessels.
THE INFLUENCE OF ERGOT-ALKALOIDS ON THE COURSE OF                            Conventional treatment based on surgery, irradiation and chemotherapy
PUERPERIUM                                                                   has proved to be ineffective. Some Authors have proposed a role of
M.Andjelic (1), A.Sabo (2), S.Aleksic (2), J.Maksimovic (1),                 female sex hormones in the progression of the disease. In fact LAM
Outpatients Service, Dom Zdravljazmaj Ognjena Vuka, Novi Sad,                occurs only in fertile women. Moreover, a worsening of LAM during
Vojvodina, Yugoslavia, 21000, (2) Universiti of Novi Sad, School of          pregnancy or use of oestrogen has been reported. Considering these data,
Medecine, Clinic of Gynecology & Obstetrics, Novi Sad, Vojvodina,            an oestrogen-dependency for such a condition has been considered
Yugoslavia.                                                                  suggesting a different therapeutic approach.
                                                                             Surgical or medical ovariectomy have been then introduced in the
Toxycology: Ergot- alkaloids are routinely used in our country in            treatment of LAM with a success rate of roughly 50% (2). Beside
puerperium as the drugs of choice for prevention of postpartal               surgical approach, several drugs may yield a complete oestrogen
haemorrhage.                                                                 deprivation such as progestagens, androgens, tamoxifene. Our patient
The aim of this work was to investigate possible positive and\or negative    has been treated for 8 years with GnRH analogues, achieving an
effects of this group of drugs on puerperas (the involution of uterus,       apparent remission of the disease and good compliance of the patient.
uterine crumps, the volume of lochia, the volume of milk) and their          Finally, this class of drugs may represent a valid alternative to the
newborns (suckling, BM). It is a prospective study.We investigated 203       oophorectomy in the treatment of LAM.
women during the first ten days of delivery. All of the women delivered      References
from 1995. to 1996.year at Gynecological and Obstetrical Clinic in Novi      1-Corrin B, Liebow AA, Friedman PJ. Pulmonary
Sad. They were given single dose of 0,2mg of methylergonovine maleat         lymphangioleiomyomatosis. A review. Am J Pathol 79(2): 348-82, 1975
together with 1UI of oxitocin I.V. in fourth stage of delivery. After that   2-Eliasson AH, Phillips YY, Tenholder MF. Treatment of
50% of them (investigating group) were given 0,1mg of                        lymphangioleiomyomatosis. Chest 196:1352-55, 1989
methylergonovine maleat per os three times per day during following ten
days. The other group (the control group) wasn`t given therapy. All
women breast-fed their babies.                                               P1.06.23
Accroding to our results there was not statistical difference between the    HYSTEROSCOPIC FINDINGS IN WOMEN ON TAMOXIFEN
groups conserning uterus involution, while the cramps that were              E. Paraskevaidis, D. Lolis, M. Paschopoulos, E. Kontostolis, S.
reported had been stronger and had appeared more frequent in the group       Kaladaridou, K. Zikopoulos, G. Adonakis, A. Kaponis, F. Avgoustatos,
of women who had recived ergot-alcaloids. Lactation was significantly        Medical School of Ioannina, Opl. Poutetsi 2, Ioannina, Epirus, Greece,
worse in the first group and because of theat 25% of their newborns had      45333.
to be fed by bottle. We concluded that there are no resons for routine use
of ergot-alcaloides for prevention of hemorrage in puerperium.               Objective: Tamoxifen therapy for the adjuvant treatment of breast cancer
                                                                             is known to cause endometrial lesions and abnormal uterine
                                                                             bleeding.The purpose of this study is the hysteroscopic evaluation of the
P1.06.22                                                                     lesions due to tamoxifen therapy.
GnRH ANALOGUES FOR THE TREATMENT OF                                          Method: In this study we present hysteroscopic photographs of the
LYMPHANGIOLEIOMYOMATOSIS: A CASE REPORT                                      lesions caused by tamoxifen on the endocervix and endometrium. We
Ghi T, G.Gentile, C.Flamigni, S.Orsola-Malpighi, via Massarenti, 13,         evaluated seventy women who had underwent modified radical
Bologna, Italy, 40100.                                                       mastectomy for breast cancer and were on tamoxifen therapy ( tab.
                                                                             Kessar 20 mgr per day ). Hysteroscopy was performed following
A 34-years-old woman was referred to the Pneumology department of            evaluation of the endometrium using transvaginal sonography. Our
our Hospital in 1991. Her familiar and previous medical history were         hysteroscopic technique is vaginoscopic approach in an outpatient basis,
unremarkable. Throughout the year she had experienced a persistent           using the Hamou I hysteroscope (Karl Storz, Tuttligen, Germany) for
mild fever and profound asthenia. Just returned from a vacation, she had     panoramic hysteroscopy and microhysteroscopy (evaluation of the
noted a worsening of her symptoms and the onset of dyspnea associated        vascularity of the endometrium).
to dorsal and thoracic pain which completely precluded her left              Results: 8 out of 70 women (11.4%) presented with abnormal uterine
decubitum. She had been administered antibiotic therapy by general           bleeding whereas 62 (88.6%) were asymptomatic. Stromal proliferation
MONDAY, SEPTEMBER 4                                                                                                                              99

was diagnosed in 24 women (41,5%), tamoxifen-polyp in 13 women             P1.07.03
(22,6%), endometrial hypervascularity in 19 women (32,5%) and              MALIGNANT LYMPHOMA OF THE CERVIX: CASE REPORT
endometrial adenocarcinoma in 2 women (3,4%).                              I.N.Alecrin, L.E.M.Patah, K.C.Camarotto, F.M.Laginha, J.A Marques,
Conclusions: Vaginoscopic hysteroscopy is a method of choice for           J.Mottola. Woman Health Reference Center, São Paulo, Brazil, 05409-
evaluation of the endometrial and endocervical lesions in women            002.
undergoing tamoxifen therapy.
                                                                           Objective: The aim of this case report is to describe an uncommon type
                                                                           of cervical cancer, a malignant lymphoma of the cervix.
P1.07 GENERAL GYN-ONCOLOGY                                                 Case Report: A 73 year-old white woman had a six months history of
                                                                           vaginal bleeding. The patient’s medical history included three vaginal
P1.07.01                                                                   deliveries, one abortion and systemic hypertension. Physical
GRANULOCYTIC SARCOMA OF THE UTERUS, ASPECTS ON                             examination revealed barrel-shaped cervix with friable, bleeding and 8
FERTILITY AND FETAL OUTCOME                                                centimeters of size lesion. The cancer extended to the upper two thirds
R. Wilborny, B. Pichler, D. Schmid, Dept. OB.GYN, General Hospital,        of the vagina. The retal examination determinated pelvic sidewall
Waidhofen/Thaya, Austria.                                                  extension. The exfoliative cytology of the cervix indicated atypical
                                                                           squamous cells of undetermined significance (ASCUS). The cone biopsy
Objectives: This study was performed to evaluate the occurrence of         was performed and the histologic diagnosis was malignant lymphoma,
pregnancy after bone marrow transplantation (BMT) and to find out the      variant small-cell. The FIGO Clinical Staging was stage IIIB cervical
incidence of granulocytic sarcoma (GS) of the uterus caused by the case    cancer. The patient underwent to chemotherapy and during her treatment
of a 19-year-old woman in our ward.                                        she died of multiorgan failure.
Study Methods: Medline literature review of reported cases of GS,          Conclusion: The malignant lymphoma of the cervix is a rare entity of
reported pregnancies in the BMT population and the report of our case.     cervical cancer. In our case, the patient died during the treatment,
Results: GS are extramedullary collections of immature leukemic cells      showing the poor prognostic of IIIB stage cervical cancer.
observed in 3 to 7% of myelogenous leukemias.
One large autopsy series described a higher incidence of GS in acute
myeloid leukemia (AML) than in chronic myeloid leukemia (CML).             P1.07.04
In the case of AML, only a subgroup with 8:21 translocation develops       AGGRESSIVE ANGIOMYXOMA OF THE PERINEUM: CASE
GS. While these tumors may occur anywhere, they have a proclivity to       REPORT AND LITERATURE REVIEW
arise adjacent to cranial and facial bones. The manifestation in the       R. Rachdi, M. Basly, L. Messaoudi, M. Chibani, Dept. OB/GYN,
uterus is very rare. Multiple case reports and a few series studies        Military Hospital, Tunis, Tunisia.
showed more than 250 offspring from BMT recipients. The pregnancy
rate ranged between 6 to 17% (mean 12%). Spontaneous abortions             Aggressive angiomyxoma is a distinctive soft tissue tumor associated
occurred in 7% of BMT patients with chemotherapy compared to 37% in        with high risk of local recurrence but lacks metastatic potential. This
a patient group who underwent BMT and total body irradiation (TBI).        tumor occurs nearly exclusively in the soft tissues of the pelvis and
Malformations occurred in 3.8% of the BMT treated group. There is no       perineum of adult women. Only 90 cases have been previously reported
higher incidence than in the general population.                           in the literature, our case being the first one in Tunisia.
Conclusions: Although GS in the genital tract is very rare, therapy is     We report a 17-year old woman swelling with a left vulvar tumor,
associated with gonadal dysfunction. Fertility of patients after BMT is    measuring 20 cm. There was no evidence of recurrence 1 year after
of concern because BMT patients are often young people who wish to         surgery.
resume a normal quality of life, for which to many patients involves the
desire to have children. The issue of counseling BMT patients about
fertility, pregnancy complications and potential birth defects is          P1.07.05
becoming increasingly complex and warrants further investigation.          ULTRA-SHORT TERM PROPHYLAXIS WITH CEFTAZIDIME IS
                                                                           EFFECTIVE IN GYNECOLOGIC ONCOLOGY SURGERY
                                                                           L. Selvaggi, G. Cormio, G. Di Vagno, A. Cazzolla, M. Lapresa, G. Di
P1.07.02                                                                   Gesu, G. Loverro, Dept. OB/GYN, University of Bari, Bari, Italy
A.Sánchez-Dehesa, M.L. Fenández-Pérez, J. Lombardía, J. Porro, M.          Introduction: To determine the efficacy of antibiotic prophylaxis with
Sanchez-Dehesa, J. Potenciano, Gynecology Oncology Unit, Dept.             ceftazidime in patients undergoing gynecologic oncology surgery.
OB/GYN, Hospital Virgen de la Salud, Toledo, Spain.                        Study Methods: Patients scheduled for gynecologic oncology surgical
                                                                           procedure, without previous significant medical pathologies, and without
A 61-year-old woman came to our urgency service presenting pelvic          anamnestic episodes of allergic reactions to cephalosporins received
pain and menometrorrhagia over the last eight months. This patient had     ultra-short antibiotic prophylaxis with ceftazidime 2 gr i.v. 30 minutes
high risk factors such as: menopause, diabetes, mellitus, hypertension     before induction of anesthesia.
and weight.                                                                Results: Until December 1999, 150 patients were enrolled in this
The abdominal ad speculum examination was made without abnormal            protocol. Surgical procedure consisted of 98 total abdominal
results; the transvaginal ultrasonographic examination revealed an         hysterectomies with or without omentectomy and peritoneal debulking,
endometrial thickness of 15 mm and a uterine leyomioma of 22x25 mm.        42 extended radical hysterectomies, 10 pelvic lymphadenectomies. In
The endometrial sampling was examined with the result of endometrial       26 patients, due to opening of the bowel or bladder, a wider antibiotic
adenocarcinoma G-3 with some clear cells.                                  treatment was necessary. Overall febrile morbidity occurred in 11
The surgical treatment (total abdominal hysterectomy and bilateral         patients and none had site-specific infections.
salpingoophorectomy and complete pelvic lymphonodectomy) was               Conclusions: Ultra-short term antibiotic prophylaxis with ceftazidime
made one week later with the microscopic examination: endometroid          appears feasible and safe in gynecologic cancer patients undergoing
adenocarcinoma G-3 over a polypoid lesion whose depth of myometrial        surgery.
invasion was less than 1/2, and a second endometrial polypus with focal
endometroid adenocarcinoma with clear cells; the rest of the endometrial
sample was atrophy.
This treatment was completed with radiotherapy (external radiation and
Five months later the patient had a metastatic abdominal tumor and liver
metastasis of 7 cm. Here she began the chemotherapy.
100                                                                                                                   MONDAY, SEPTEMBER 4

P1.07.06                                                                    Results: 100% of patients had the signs of thrombophylia before the
BIOPSYCHOSOCIAL APPROACH IN THE EVALUATION OF                               surgery. In 44 patients (10%), we have revealed the circulation of APA.
FULL PAIN OF PATIENTS WITH GYNECOLOGICAL AND                                Low-molecular weight heparin (LMWH) Fraxiparin was administered
BREAST CANCER WITHOUT THERAPEUTICAL CHANCES                                 subcutaneously in the prophylactic dose of 150 ICU/kg, once daily,
J.J.R. Mottola, L. Diniz, C. Felipe, N. Garcia, A.C. Santos, F.M.           preoperatively. The therapy was continued 8 hours after surgery for 10
Laginha, I.N. Alecrin, J.A. Marques, Center of Reference for Women’s        days at the dosage of 150 ICU once daily.
Health, São Paulo, Brasil.                                                  Conclusion: The drug was found to have a significant effect on the
                                                                            prevention of thrombosis: D-dimer left to the normal level on the 10th
Objectives: The objective of this study was to make an adequate and         day of treatment. No incidence of thrombosis or hemorrhage had been
systemized evaluation of the patients considered without perspectives of    revealed during treatment.
curing treatment in the unit of palliative care (UCP).
Study Methods: The authors studied 600 patients attended to during the
period of Jan. 1993 to Aug. 1998 at the unit of palliative care of the      P1.07.09
Center of Reference for Women’s Health. The patients with                   HRT IN WOMEN WITH GYNECOLOGICAL MALIGNANCY
gynecological cancers and breast cancer considered by the oncological       M. Bendová, J. Jenicek, J. Zivny, Dept. OB/GYN, Faculty of Medicine
team as being without any therapeutic chances were admitted at the UCP      Charles University, Prague, Czech Republic.
for control of pain and correction or adaptation of the physical
conditions required for the improvement of their quality of life.           Objective: In the past, hormonal replacement therapy was not
Results: The family monthly income of 84.8% of the patients varied          recommended to patients with gynecological malignancy after
from $100US to $300US and 25% lived in slums. Only 41% were fully           ovarectomy because of the fear of a relapse of the basic disease.
aware of the disease and its evolution and 20% did not recognize its        Gradually it was revealed that not all gynecological malignancies are
seriousness. 48.5% presented reactive depression, 14.2% of the patients     hormone-dependent, and, therefore, HRT does not mean an aggravated
showed anxiety and only 14.6% recognized and accepted the real              risk to the woman’s health. HRT was then applied to selected group of
situation of the disease. In 63% of the cases, relatives were the main      women after surgical or radiation castration for the reason of
care givers. Facilitation the biopsychosocial intervention for correction   gynecological malignancy.
of family maladjustments, prejudice with disease, control of symptoms       Study Methods: Our study included group A consisting of 52 women
and instruction were given to the patients and family, besides the          after surgical ovarectomy or consequential radiation for the reason of
financing and legal support when required.                                  malignancy of their reproduction system. The women in group A started
Conclusion: The authors conclude that the multidisciplinary intervention    applying HRT shorter or later after ovarectomy. The second group B
in families and patients considered without therapeutic possibilities a     includes 52 women of a comparable age after surgical ovarectomy for
significant reduction in the full pain with decrease quantity and drug      the reason of gynecological malignancy, who did not receive hormonal
toxicity for pain control.                                                  therapy. Both groups received dietary calcium. The following
                                                                            parameters were monitored in groups during the period of 3.5 years after
                                                                            the beginning of HRT application: status performance, patient’s
P1.07.07                                                                    stabilized oncological status (i.e. negative palpation, tumor markers,
AN UNUSUAL EXTRAPERITONEAL PELVIC MASS                                      ultrasonography, mammography), levels of gonadotropins, status of
HEMANGIOPERICYTOMA: REPORT OF A CASE WITH                                   urogenital system, biochemical markers, bone density, parameters of
LITERATURE                                                                  sexual life, mental condition and subjective climacteric symptoms.
C.H. Roan (1), W.W. Liang (2), F.M. Chen (1)                                Results: The group A started HRT with worse parameters as the
(1) Dept. OB/GYN, Wang-Fan Hospital, Taipei Medical College,                application began later after castration than is usual in menopausal
     Taipei, Taiwan.                                                        women in population without malignancy. A significant improvement
(2) Dept. Pathology, Taipei Municipal Women’s & Children’s                  was seen in nearly all parameters monitored in women in group A after
     Hospital, Taipei, Taiwan.                                              treatment lasting 3.5 years on average, compared with group B, and no
                                                                            case of relapse of the basic oncological disease occurred. On the
Hemangiopericytoma is a rare solid mass in the pelvis and is first          contrary, in one woman from group B (without HRT) occurred
described by Stout and Murray in 1942. We will present our experience       progression of the basic oncological disease and in two women second
with the clinicopathologic features for an unusual pelvic mass that had     malignancy (Ca mammae) appeared during the study period. In another
been pathologically confirmed to be hemagiopericytoma.                      woman without HRT a fracture of right hand occurred.
The patient is a 45-year old housewife, native of Taiwan. She suffered      Conclusions: It is apparent that surgically-menopausal women with
from a lower abdominal mass. Image studies were performed, including        gynecological malignancy can benefit from HRT and their quality of life
CT, X-ray, Radio-isotope Ga67 scan and Sonar in pre-operative               can be improved. No negative influence of HRT on the remission of the
condition. The clinicopathologic finding will be demonstrated in this       basic oncological disease was observed in our study throughout the
article.                                                                    entire period of application.

P1.07.08                                                                    P1.07.10
CANCER AND THE HISTORY OF THROMBOSIS                                        D. Vineyard, Dept. OB/GYN, Scott & White/Texas A&M University,
A.D. Makatsaria, A.M. Chabrov, Dept. OB/GYN, Moscow Medical                 Temple, Texas, USA
Academy, Moscow, Russia.
                                                                            Background: Pulmonary blastoma is a rare primary lung malignancy,
Objective: The aim of the study was to investigate the effect of LMWH       first described in 1945, composed of mixed epithelial and mesenchymal
(Fraxiparin) in women with genital cancer and the history of thrombosis.    composition that recapitulates the fetal lung at 10 to 16 weeks gestation.
Study Methods 22 women were included in this study. All of them had         Histologically it consists of undifferentiated embryonic connective tissue
genital cancer of different localization: 8 women with the I stage of       lined by vacuolated columnal epithelium, simulating fetal bronchioles.
endometrium cancer and 14 with the I-III stage of ovarian cancer. All       The epithelial component often forms morulae, balls of squamous cells
had one or more thrombotic events in their history: 1 woman had an          with the appearance of squamous metaplasia. Presentation is often
acute myocardial infarction, 1 a pulmonary thromboembolism and the          asymptomatic, or nonspecific symptoms such as fever, dyspnea, cough,
others had a history of deep vein thrombosis. We used special               hemoptysis, and chest pain may be the presenting complaints. Although
coagulation tests to determine the signs of thrombophylia: TAT, F1+2,       indolent in presentation, this is an aggressive malignancy, with a five-
D-dimer and others. The circulation of antiphospholipid antibodies          year survival rate of 16 percent. Surgical resection is the therapy of
(APA) (anticardiolipins and/or lupus anticoagulant LA) was detected         choice.
through ELISA method, PTT-LA (Stage, France) and also through               Case: We present the case of a 34-year old woman who presented with
conformational probes with platelets lizats – PNP STAGO France).            complaints of abdominal pain and constipation. On evaluation, she was
                                                                            found to have a 10 cm pelvic mass displacing her uterus to the side, and
MONDAY, SEPTEMBER 4                                                                                                                                101

a 7 cm solitary lesion in the right lower lobe of the lung was noted on      malignancy to its appropriate origin. Therefore leading to appropriate
abdominal radiographs. The lung mass was resected in a right lower           management.
lobectomy, and an exploratory laparotomy was performed, with total
abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node
dissection, cytology and omentectomy. Pathological diagnosis was             P1.08 HIGH RISK PREGNANCY 1
biphasic pulmonary blastoma of the right lung, with metastasis to the
right ovary. Diagnostic criteria, histology and special stains are           P1.08.01
discussed.                                                                   SERUM CONCENTRATIONS OF INHIBIN AND ACTIVIN
Conclusions: Pulmonary blastoma is a rare primary lung malignancy.           IN NORMOTENSIVE AND HYPERTENSIVE PREGNANCIES.
To our knowledge, this is the first documented case of a pulmonary           F. Casper, R. Seufert_, M. Schaffrath, M. Hofmann_, K. Pollow
blastoma metastasis to the ovary.                                            Dept. Exp. Endocrinology & Dept. OB/GYN_, University Mainz,

P1.07.11                                                                     Objectives: The etiology of preeclampsia is still unknown. Researchers
AMISH AND NON-AMISH WOMEN'S USE OF                                           have measured a number of different biochemical parameters to find a
COMPLEMENTARY AND ALTERNATIVE MEDICINE                                       predictive factor typical for preeclampsia. The goal of the present study
VE von Gruenigen, A Showalter, LJ White, MP Hopkins, MS Mazi, EL             was to measure the serum concentrations of the ovarial
Jenison. Northeastern Ohio Universities College of Medicine, Akron,          proteohormones in normotensive and hypertensive pregnancies.
OH, USA, 44307.                                                              Study Methodsned 30 women with preeclampsia (PE), 8 with HELLP
                                                                             syndrom (HS) , 5 had chronic hypertension and 52 were normotensive.
Objective: To compare the use of complementary and alternative               Results During pregnancy, the serum levels of all four parameters
medicine (CAM) between Amish and non-Amish OB/GYN patients.                  continually increase and fall within partuition. Activin A shows
Methods: 357 GYN patients completed a questionnaire regarding their          significantly higher serum concentration levels in patients with HS (p=
use of CAM.                                                                  0.012). For Inhibin A preeclamptic patients (p=0.021) and women with
Result: The typical non-Amish patient (n=291) was 46 years old,              HS (p= 0.012) significant, higher serum concentration levels were
Caucasian (95%), finished high school, (78%), married (62%),                 found in comparison to normotensive pregnant women. Women with
employed (58%), and was being seen for a Pap test. Currently, 56% of         chronic hypertension showed minor inhibin A levels in comparison to
the patients were using CAM, including; nutritional supplements (20%),       preeclamptic patients (p = 0.042), but no statistically difference to
prayer (17%), exercise (12%), and green tea (10%). 27% discussed these       normotensive women.
therapies with their gyne-cologist. Mean cost of CAM was estimated at        Conclusions The increase in activin A and inhibin A, is being discussed
$640. Only 13% of insurance companies covered this expense. A                as hormonal counter regulators to patho-physiological changes like
perceived benefit from CAM use was reported by 68%. The typical              inadequate vessel development and reduced feto-maternal circulation.
Amish patient (n=66) was 25yrs old with an 8th grade education, and
married (95%). Pregnancy was the reason for 63% of the visits. 31%
were using CAM, the most common being vitamins (30%), Echineacea             P1.08.02
(25%), and St. John's Wort (10%). 26.7% informed their doctor of CAM         PLACENTA ABRUPTION IN HIGH RISK PREGNANCIES
use. Although 77% of the Amish women rated CAM as helpful, they              R. Ljubomir, P. Branislav, R. Goran, M. Ivana, M. Nemanja,
were unable to estimate its cost.                                            Gynecology and Obstetrics Clinic, Belgrade, Yugoslavia.
Conclusion: Types of CAM used were dissimilar between Non-Amish
women who used CAM more often than Amish women (p=0.003).                    Authors present incidence of placenta abruption in the period 1991-1997
More Amish women reported a beneficial response from these therapies.        in women who delivered in the Gynecology and Obstetrics Clinic in
Patients who use CAM perceived them as helpful, although no                  Pristina. During this time there were 45,961 deliveries in which
published data support that claim                                            occurred 697 (1.52%) placenta abruptions of different degrees.
                                                                             Results are presented on 8 tables: Table 1 presents number of deliveries
                                                                             and abruptions of placenta. Table 2 presents degrees of placenta
P1.07.12                                                                     abruptions of which there were 27 (3.87%) with uteroplacenta
SIGNET-RING CELL CARCINOMA OF THE APPENDIX                                   apopection.
PRESENTING AS A RIGHT ADNEXAL MASS: A CASE REPORT                            Age of patients is presented in table 3; about 67% were under the age of
AND LITERATURE REVIEW                                                        30. Table 4 presents parity of parturians; 66% had four or more
J. Tadvick, C. Capen, Scott and White Hospital, 2401 South 31st Street,      deliveries.
Temple, Texas, United States, 76508.                                         Analysis of incidence of placenta abruptions in relation to the season are
                                                                             presented in table 5; Spring 37.61%, Summer 11.9%, Autumn 34.67%,
Ojectives : The purpose of this study was first to present this unique and   and Winter 15.80%. Complication deliveries are presented in table 6;
interesting case and second that observation and careful disection will      557 (79.91%) had spontaneous delivery, 140 (20.09%) Caesarean
lead to the appropriate diagnosis.                                           Section, in 37 (26.42%) cases with Hysterectomy. Table 7 presents
Study Materials : A case involves a 25 year old who is evaluated for an      gestational age of pregnancies; 227 (32.56%) were premature deliveries.
adnexal mass. The physical exam, imaging studies and elevated CA 125         There were 223 (31.99%) stillbirths (table 8). There was no maternal
are all consistent with an ovarian primary mass. At surgery the tumor        death.
was noted to be infiltrating rather than spreading along the surface which
would be more consistent with ovarian cancer. This lead to careful
abdominal exploration and the appendix was noted to be involved with         P1.08.03
cancer. General Surgery was consulted for appropriate surgical               DOPPLER VENOUS MEASUREMENTS IN ASSESSMENT OF
management. The patient was debulked and started on Methotrexate, 5          PREGNANCY WITH IDIOPATIC OLIGOHYDRAMNION
Florouricil and Leucovorin chemotherapy. No regression of disease was        N. Cerovic, S. Rakic, Z. Mikovic, N. Antic, Dept. OB/GYN, University
noted and the patient died approximately 4 months later.                     Clinic “Narodni Front”, Belgrade, Yugoslavia.
Results : Review of the literature reveals only 7 other cases of Signet-
ring cell carcinoma of the appendix. These either presented as acute         Objectives: The aim of the study was to investigate changes in venous
appendicitis or appendiceal abcess. This is the first case of this tumor     blood flow of fetuses (ductus venosus and vena cava inferior) in
presenting as an adnexal mass. The prognosis is poor with this               pregnancies with idiopatic oligohydramnion and to consider time
malignancy because of advanced stage at the time of diagnosis.               correspondence with changes in arterial blood flow (a. umbilicalis and a.
Conclusion : Most Gynecologic Oncologists will never see a Signet-ring       cerebri media).
cell carcinoma of the appendix or colorectal system. We present this         Study Methods: Thirty-six singleton pregnancies between 25 and 39
case because any GI malignancy can present as an adnexal mass. As            weeks of gestation with evident oligohydramnion (AFI<5) were studies
with any malignancy with extensive metastasis, careful dissection and        using color Doppler ultrasound. All fetuses were chromosomal and
anatomical identification can allow the surgeon to classify the              genetically correct. The measurements included Pi of a. umbilicalis and
                                                                             Pi of a. cerebri media and C/U ratio were computed. Also we measured
102                                                                                                                     MONDAY, SEPTEMBER 4

PIV and PVIV of ductus venosus and v. cava inferior. Results were            reviewed from record charts. The matched cohort study design for
analyzed with an adverse outcome.                                            parity, gestational age, nationality and gender of neonates from normal
Results: Group A – fetuses with a normal C/U ratio did not show              pregnancies in the hospital was used. The weight gain during pregnancy
significant difference in PIV and PVIV of VCI and DC compared to             and visits to antenatal clinics were compared. Pregnancies with multiple
normal fetuses. Group B – fetuses with C/U ratio>95th centile had            gestation, diabetes or other maternal diseases were excluded. The PET
significant difference in PIV and PVIV of VCI and DV compared to             was associated with poor clinical attendances leading to poorly
normal fetuses. This group corresponding to abnormal outcomes had a          controlled PET (p=0.0009), increased maternal weight gain (13.7 KG v/s
shorter interval between diagnoses and delivery and proceeded onset of       7.4 KG), higher premature deliveries (18.69% v/s 3.50 %, p=0.02) ,
late decelerations.                                                          higher operative deliveries (30.08% v/s 12.3%, p=0.0001 ), neonatal
Conclusions: In cases with oligohydramnion which included                    deaths (4.06% v/s 0.49%). The PET leads to IUGR in neonates, weight
compromised fetuses with redistribution blood flow to the fetal head,        (2.64 KG v/s 3.05KG p=.001), severe PET v/s controls (1.83KG v/s
assessment of the PIV and PVIV of the inferior vena cava and the ductus      2.43KG p=0.01), head circumference (31.54cm v/s 33.07 cm, p = 0.001)
venosus predicted adverse outcome.                                           and the length ( 47.37 cm v/s 48.66 cm, p=0.003)
                                                                             The nationality, age of the patient and gender of neonate had no bearing
                                                                             on outcome. Statistical analysis was performed through computer
P1.08.04                                                                     programme Statistica 5.0 . The PET is not preventable but the outcome
IMMONULOGICAL BACKGROUND OF RECURRENT FETAL                                  can be improved by educating childbearing females about the early
WASTAGE                                                                      symptoms of disease, continuous education of doctors in primary health
T. Tamara, S. Hilal, Dept. OB/GYN, Ain Shams University Hospital,            clinics and MCH to pick early cases of PET and to refer them for close
Cairo, Egypt.                                                                monitoring by obstetricians in appropriate centers.

Objectives: The aim of the study was to detect whether it is thrombosis
of vasculitis which affects the blood vessels of the placenta and            P1.08.07
umbilical cord in cases of lupus pregnancy in order to choose the proper     PECULIARITIES OF PREGNANCY DURATION AND HORMONAL
treatment accordingly.                                                       BALANCE AFTER LAPAROSCOPIC TREATMENT IN PATIENTS
Study Methods: One hundred and seventy-six pregnant SLE patients             WITH POLYCYSTIC OVARIES SYNDROME (PCOS)
with history of previous fetal wastage were studied. All patients had the    L. Nadareishvili, S. Kherodinashvili, A. Khomassuridze, Zhordania
following laboratory tests; ANA, An DNA, Sm, nRNP and                        Institute of Human Reproduction, Tbilisi, Georgia
antineutrophil cytoplasmic antibodies. Umbilical cord and placental
pathology were part of the study. IFAT staining for immune complex           Materials and Methods: 60 pregnant women who underwent
deposition in placental or cord blood vessels was done using seven           laparoscopic demedulation and electric cauterization of polycystic
stains.                                                                      before pregnancy were investigated. Transabdominal ultrasonography,
Results: Antineutrophil cytoplasmic antibodies (at least one type) was       dynamic cardiotocography, blood serum and daily urine hormone
positive in thirty six percent. Pathology revealed vasculitis in 39.6% and   analysis were used in the research.
thrombosis in 25.4%. IFAT staining was positive in 13.6%.                    Results: The results showed that in 44 cases the threatened pregnancy
Conclusion: It seems that vasculitis contributes to placental pathology in   loss was diagnosed: 18 patients had second, third-trimester fetal and
cases of lupus pregnancy by a major percentage. Thus, it seems that a        placental insufficiency, 5-second, third-trimester gestosis; 15 fetal
low dose corticosteroid is important to prevent or minimize this             hypoxia; 2-third trimester intrauterine growth retardation, 7-premature
pathology.                                                                   rupture of fetal membranes and preterum labor. We revealed different
                                                                             hormonal disorders in these patients: reduction in the secretion levels of
                                                                             serum chronic gonadotropin, progsteron, placental lactogen, estradiol,
P1.08.05                                                                     pregnandiol excretion levels during all trimesters; first-trimester rise in
ANTIMALARIAL DRUGS IN SLE PREGNANT PATIENTS                                  17-ketosteroids testosterone concentration.
T. Tamara, Dept. OB/GYN, Ain Shams University Hospital, Cairo,               Conclusion: The results of our study suggest after achieve treatments
Egypt.                                                                       and prophylactic measurements on the basis of pregnancy monitoring.
                                                                             Spontaneous abortion and complicated gestosis rate was markedly
Objectives: The aim of the study was to study to effect of antimalarial      decreased. The timely diagnosis and corrected fetal, placental
drugs in pregnant SLE patients and to find whether it is safer to continue   insufficiency prevent fetal hypoxia, intrauterine growth relation and
or to stop the drug used.                                                    perinatal death.
Study Methods:One hundred and seventy-six pregnant SLE patients
were included in the study. They were divided into two groups. Group
A patients continued receiving antimalarial therapy and group B patients     P1.08.08
stopped taking the drug. Both groups were followed for fetal maturity        CONDITION OF REGULATIVE SYSTEMS OF THE PREGNANT
and wellbeing.                                                               WOMEN WITH DIABETES MELLITUS
Results:In group A, the rate of spontaneous abortion was 4%, fetal death     Nizova N.
7%, live birth 89%, intrauterine growth retardation 23% and fetal
distress 21%. In group B, the rate of spontaneous abortion was 6%, fetal     The purpose: study of a condition of haemodynamic reactions and
death 9%, live birth 85%, intrauterine growth retardation 37% and fetal      metabolic processes at the pregnant woman with Diabetes Mellitus.
distress 34%. The rate of flare in group A was 24%, while in group B         Methods of inspection: 149 pregnant women with Diabetes Mellitus
53%. No congenital fetal abnormalities were encountered in both              (DM) were surveyed in dynamics: 52 of them - with uncomplicated,
groups.                                                                      mild current of disease and pregnancy and 97 - with serious DM, which
Conclusion:It seems that hydroxychoroquine in a dose of 200-400              was combined with various obstetric complications. For definition of
mg/day is safe in lupus pregnancy. Also, it is more advantageous to          parameters of the central haemodynamics we used a method tetrapolar
continue antimalarial therapy in lupus patients who become pregnant          rheography. The blood gases were determined through the automatic
rather than to discontinue the drug.                                         microanalyzator «Stat-profile-2» USA. A condition of a fetus was
                                                                             determined according to parameters of a biophysical profile of a fetus.
                                                                             Results: The pregnant women with DM had infringement of mechanisms
P1.08.06                                                                     of acclimatization of cardiovascular system. So, during the maximal
NEONATAL OUTCOME AFTER PREECLAMPSIA TOXEMIA,                                 strain of haemodynamic reactions - 26-32 weeks of pregnancy have
CAN WE IMPROVE THE OUTCOME?                                                  increased twice general periphery resistance, that was accompanied by
Gautam Gursarup, FRCOG, consultant, Fujairah Hospital, Fujairah,             decrease by 40 % of shock and minute volumes of heart. Have
UAE .                                                                        determined decrease twice of oxygen volume and augmentation in 1,5
                                                                             times of an index of a fabric extraction O2, that testifies to development
Our goal was to identify available parameters in PET patients that could     of hypoxia, owing to hemodynamic infringements. By us it is revealed
predict the outcome of neonates. From Jan 95 to Dec 97, 123 patients         chronic hypoxia of a fetus in 86,7_4,1 % of cases, besides
delivered in our hospital with diagnosis of PET were retrospectively         decompensated and subcompensated at 28,4 + 1,3 % of the women with
MONDAY, SEPTEMBER 4                                                                                                                                103

serious and labile current DM 9,8±0,86 %, that substantially reduces          degree myopia patients was cesarean operation section of high degree
opportunities of acclimatization of a fetus to a hypoxia during labors.       myopia.
Conclusions: the infringements of basic regulator systems initiate            Study Methods: The impedance rheocardiography by Kubicek,
process of a disadaptation to pregnancy at Diabetes Mellitus, that initiate   impedance rheoencephalography by Paleev, rheoophtalmography and
irreversible complications in the system «mother - placenta-fetus» , that     tonometry methods have been used.
demands the new approaches to correction of metabolic infringements           Results: All patents in 1 period of partus had normal parameters of blood
since the first weeks of pregnancy.                                           circulation, cerebral blood flow. During uterus constractions in the
                                                                              second period of partus the patients with high degree myopia had an
                                                                              increase of cerebral blood flow. Between uterus constraction the
P1.08.09                                                                      patients of this group had normal parameters of blood circulation and
OUTCOME OF IDDM IN PREGNANCY IN LATVIA 1989 – 1999                            cerebral blood flow. The healthy women in the second period of partus
N. Kalashnikova, S. Vitina, M. Tutere, Dept. OB/GYN, P. Stradin               had angiospasm phenomen and the increase of cerebral blood flow. The
University Hospital, Pilsonu, Latvia.                                         opthalmic hemodynamics was changed in all patients with high myopia
                                                                              degree during the first investigation. The normalization of cerebral
Objectives: The aim of the study was to analyze the effect of glicemia        blood circulation obtained by intravenous infusion pyracetam. The
self-monitoring on pregnancy outcome in type I diabetes.                      improvement of ophthalmic hemodynamics was obtained by intravenous
Study Methods: Since 1989 through 1999, 103 type I diabetics gave             infusion of spasmolytics. The ophthalmic hemodynamics parameters
birth in the specialized center in P. Stradin University Hospital. The        did not change in partusm, nor did they change 7 days after partus.
women were divided and results analyzed in two groups: I – 36 who             Conclusions: The epidural anesthesia promotes the optimization of
delivered in 1996-1998 after the introduction of self-monitoring, and II –    partus in high degree myopia patients.
67 who delivered in 1989-1995. Age with class, parity, complications in       The intravenous infusion of pyracetam and spasmolytics promote the
the current and previous pregnancies, during the delivery and outcome         optimization of central hemodynamics parameters, cerebral blood flow
of the neonate were registered.                                               and ophthalmic blood circulation.
Results: No difference in age, parity, duration of diabetes and White
classes was noted between the two groups. There were fewer PIH in I
group (not statistically reliable). 20 (80%) of neonates in the I group       P1.08.12
were delivered after 37 w.g., compared to 12 (17.9%) in the II group.         TRENDS OF ECLAMPSIA IN A TEACHING HOSPITAL OF
No differences in CS frequency were noted. 4 (15.4%) in the I group           CENTRAL BIHAR
were LGA, 26 (38.8%) – in the II group. No case of severe asphyxia or         S. Roy, A. Singh, A. Pandey, H. Roy, S.Roy, S. Roy,
antenatal death was noted in the I group, compared to 17 (25.8%) and 6        Dept. OBS/GYN, Patna Medical College and Hospital, Bihar, India
(8.8%) correspondingly. Perinatal mortality in the I group in this study
was 0, in the II group – 238.0‰. Economical effect of glicometer              Objectives: The aim of this study was to find out the prevalence of
provision to the pregnant diabetic was estimated at 4712.5 USD per            eclampsia during 8 successive year from 1991 to 1998 and to evaluate
healthy neonate.                                                              the impact of MCH care on its incidence and epidemiological factors as
Conclusion: Self-monitoring during pregnancy improves quality of              evident by hospital statistics.
glicemia correction and as a result, life and health prognosis for fetus of   Study Method: Cases of eclampsia admitted at Patna Medical College
type I diabetic mother. Investment in proper antenatal care of pregnant       Hospital from January 1991 to August 1998 were studied retrospectively
diabetics saves economical resources for other priorities.                    for its incidence, epidemiological factors, mode of delivery, maternal